Texas's standard order under Health and Safety Code Chapter 166 directing EMS and other health care professionals in out-of-hospital settings, including physician offices, hospital clinics and emergency departments, not to start CPR, pacing, defibrillation, advanced airway management or artificial ventilation. The attending physician signs it with the patient or a legal representative. It takes effect on signing, lasts until revoked or death, and comfort care continues.
The declarant signs the one section that fits: A for a competent adult, B for a guardian, agent or proxy, C for a qualified relative, or E for a parent of a terminally ill minor, with two witnesses or a notary. The attending physician signs the Physician's Statement with license number, or executes Section D or F; PAs and NPs cannot sign it.
First fill in the person's full legal name, date of birth and sex at the top. Section A is for a competent adult at least 18 years old, who signs, dates and prints their name. If a competent person cannot write their name, DSHS advises having them make a mark, with physicians and witnesses present, and attaching a signed witness statement confirming the mark and competence.
Used when the adult is incompetent or otherwise mentally or physically incapable of communication and has a legal guardian, an agent in a medical power of attorney, or a proxy in a directive to physicians. The representative checks the matching box, signs, dates and prints their name, acting on the person's known desires or best interest.
Used when the incapacitated adult has no guardian, agent or proxy. A qualified relative under HSC §166.088 signs, in priority order: spouse, reasonably available adult children, parents, then nearest living relative. The relative checks the box, signs, dates and prints their name.
The attending physician executes the order for a now-incompetent person after seeing evidence of their prior directive to physicians, or after observing a competent person issue an OOH-DNR in a nonwritten manner before two witnesses. Check the applicable box, sign, date, print your name and enter your license number.
For a person under 18 whom a physician has diagnosed with a terminal or irreversible condition. The minor's parent, legal guardian or managing conservator checks the matching box, signs, dates and prints their name. Two witnesses or a notary must still see this signature, and the attending physician completes the Physician's Statement.
Two competent adult witnesses sign, date and print their names, confirming they saw the declarant sign in Section A, B, C or E, or saw a nonwritten issuance for Section D. Witness 1 must be qualified: not a decision-maker, relative, heir, creditor of the estate, the attending physician or their employee, or facility staff giving direct care. A notary may replace the witnesses, except for Section D.
The attending physician confirms the order is noted in the person's medical records and directs out-of-hospital professionals, including hospital emergency departments, not to start or continue CPR, transcutaneous pacing, defibrillation, advanced airway management or artificial ventilation. Sign, date, print your name and enter your license number. Electronic signatures must meet HSC §166.011.
For an incompetent adult with no guardian, agent, proxy or available relative, when resuscitation is in reasonable medical judgment ineffective or not in the person's best interest. The attending physician and a second physician not involved in treatment, or representing the facility's ethics or medical committee, sign, date, print names and give license numbers. No witnesses or notary are needed.
Everyone who signed above signs again in the bottom block: the person, the guardian, agent, proxy or relative, the attending physician, the second physician, both witnesses and the notary, as applicable. This second signature acknowledges the document was properly completed, and EMS can refuse a form where it is missing.
Download the current version from the source each time; forms change without notice.
Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order
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Sources for this guide
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No. DSHS states that only the attending physician can sign the Physician's Statement. Section D is also executed by the attending physician, and Section F needs the attending physician plus a second physician who is not involved in the patient's treatment or represents the facility's ethics or medical committee. Physician assistants and nurse practitioners cannot sign these parts.
Not if two qualified witnesses sign. A notary may witness the declarant's signature instead of the two witnesses, but a notary cannot acknowledge an order made in a nonwritten manner to the physician under Section D; that needs two witnesses. No witness or notary is needed when two physicians execute the order in Section F.
Yes. Copies made before or after the form is filled out should be accepted like the original, and an approved OOH-DNR bracelet or necklace is honored in place of the form. A photo of the order on a cell phone is not an acceptable substitute, because Chapter 166 does not allow it as a paper copy.
Yes. Texas Health and Human Services and DSHS post the OOH-DNR in English and Spanish, each with matching FAQs and step-by-step completion instructions. The current form is effective October 2023, and the completion instructions were updated in May 2026. Some systems need the PDF opened in Adobe Reader rather than a browser viewer.