TEX. HEALTH & SAFETY CODE § 166.033
TITLE 2. HEALTH
SUBTITLE H. PUBLIC HEALTH PROVISIONS
CHAPTER 166. ADVANCE DIRECTIVES
SUBCHAPTER C. OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDERS
Tex. Health & Safety Code § 166.082 (2000)
Chapter 166, Advance Directives
§ 166.082. Out-Of-Hospital DNR Order; Directive to Physicians
(a) A competent person may at any time execute a written out-of-hospital DNR order directing health care professionals acting in an out-of-hospital setting to withhold cardiopulmonary resuscitation and certain other life-sustaining treatment designated by the board.
(b) The declarant must sign the out-of-hospital DNR order in the presence of two witnesses who qualify
under Section 166.003, at least one of whom must be a witness who qualifies under Section 166.003(2). The witnesses must sign the order. The attending physician of the declarant must sign the order and shall make the fact of the existence of the order and the reasons for execution of the order a part of the declarant's medical record.
(c) If the person is incompetent but previously executed or issued a directive to physicians in accordance with Subchapter B, the physician may rely on the directive as the person's instructions to issue an out-of-hospital DNR order and shall place a copy of the directive in the person's medical record. The physician shall sign the order in lieu of the person signing under Subsection (b).
(d) If the person is incompetent but previously executed or issued a directive to physicians in accordance with Subchapter B designating a proxy, the proxy may make any decisions required of the designating person as to an out-of-hospital DNR order and shall sign the order in lieu of the person signing under Subsection (b).
(e) If the person is now incompetent but previously executed or issued a medical power of attorney
designating an agent, the agent may make any decisions required of the designating person as to an
out-of-hospital DNR order and shall sign the order in lieu of the person signing under Subsection (b).
(f) The board, on the recommendation of the department, shall by rule adopt procedures for the disposition
and maintenance of records of an original out-of-hospital DNR order and any copies of the order.
(g) An out-of-hospital DNR order is effective on its execution.
§ 166.083. Form of Out-Of-Hospital DNR Order
(a) A written out-of-hospital DNR order shall be in the standard form specified by board rule as
recommended by the department.
(b) The standard form of an out-of-hospital DNR order specified by the board must, at a minimum, contain the following:
(1) a distinctive single-page format that readily identifies the document as an out-of-hospital DNR order;
(2) a title that readily identifies the document as an out-of-hospital DNR order;
(3) the printed or typed name of the person;
(4) a statement that the physician signing the document is the attending physician of the person and that the physician is directing health care professionals acting in out-of-hospital settings, including a hospital emergency department, not to initiate or continue certain life-sustaining treatment on behalf of the person, and a listing of those procedures not to be initiated or continued;
(5) a statement that the person understands that the person may revoke the out-of-hospital DNR order at any time by destroying the order and removing the DNR identification device, if any, or by communicating to health care professionals at the scene the person's desire to revoke the out-of-hospital DNR order;
(6) places for the printed names and signatures of the witnesses and attending physician of the person and the medical license number of the attending physician;
(7) a separate section for execution of the document by the legal guardian of the person, the person's proxy, an agent of the person having a medical power of attorney, or the attending physician attesting to the issuance of an out-of-hospital DNR order by nonwritten executed or previously issued directive to physicians under Section 166.082(c) that includes the following:
(A) a statement that the legal guardian, the proxy, the agent, the person by nonwritten means of communication, or the physician directs that each listed life-sustaining treatment should not be initiated or continued in behalf of the person; and
(B) places for the printed names and signatures of the witnesses and, as applicable, the legal guardian, proxy, agent, or physician;
(8) a separate section for execution of the document by at least one qualified relative of the person when the person does not have a legal guardian, proxy, or agent having a medical power of attorney and is
incompetent or otherwise mentally or physically incapable of communication, including:
(A) a statement that the relative of the person is qualified to make a treatment decision to withhold cardiopulmonary resuscitation and certain other designated life-sustaining treatment under Section 166.088 and, based on the known desires of the person or a determination of the best interest of the person, directs that each listed life-sustaining treatment should not be initiated or continued in behalf of the person; and
(B) places for the printed names and signatures of the witnesses and qualified relative of the person;
(9) a place for entry of the date of execution of the document;
(10) a statement that the document is in effect on the date of its execution and remains in effect until the death of the person or until the document is revoked;
(11) a statement that the document must accompany the person during transport;
(12) a statement regarding the proper disposition of the document or copies of the document, as the board determines appropriate; and
(13) a statement at the bottom of the document, with places for the signature of each person executing the document, that the document has been properly completed.
(c) The board may, by rule and as recommended by the department, modify the standard form of the
out-of-hospital DNR order described by Subsection (b) in order to accomplish the purposes of this subchapter.
(d) A photocopy or other complete facsimile of the original written out-of-hospital DNR order executed under this subchapter may be used for any purpose for which the original written order may be used under this subchapter.
§ 166.092. Revocation of Out-Of-Hospital DNR Order
(a) A declarant may revoke an out-of-hospital DNR order at any time without regard to the declarant's
mental state or competency. An order may be revoked by:
(1) the declarant or someone in the declarant's presence and at the declarant's direction destroying the order form and removing the DNR identification device, if any;
(2) a person who identifies himself or herself as the legal guardian, as a qualified relative, or as the agent of the declarant having a medical power of attorney who executed the out-of-hospital DNR order or
another person in the person's presence and at the person's direction destroying the order form and removing the DNR identification device, if any;
(3) the declarant communicating the declarant's intent to revoke the order; or
(4) a person who identifies himself or herself as the legal guardian, a qualified relative, or the agent of the declarant having a medical power of attorney who executed the out-of-hospital DNR order orally stating the person's intent to revoke the order.
(b) An oral revocation under Subsection (a)(3) or (a)(4) takes effect only when the declarant or a person
who identifies himself or herself as the legal guardian, a qualified relative, or the agent of the declarant having a medical power of attorney who executed the out-of-hospital DNR order communicates the intent to revoke the order to the responding health care professionals or the attending physician at the scene. The responding health care professionals shall record the time, date, and place of the revocation in accordance with the statewide out-of-hospital DNR protocol and rules adopted by the board and any applicable local out-of-hospital DNR protocol. The attending physician or the physician's designee shall record in the person's medical record the time, date, and place of the revocation and, if different, the time, date, and place that the physician received notice of the revocation. The attending physician or the physician's designee shall also enter the word "VOID" on each page of the copy of the order in the person's medical record.
(c) Except as otherwise provided by this subchapter, a person is not civilly or criminally liable for failure to act on a revocation made under this section unless the person has actual knowledge of the revocation.