Out of Hospital DNR Texas: What Families Need to Know

If your parent has a terminal illness or advanced dementia and doesn't want aggressive resuscitation when they collapse at home or in assisted living, a hospital-based DNR order won't help. Texas requires a specific Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) order for settings outside a hospital.

Without it, EMS is legally required to begin full resuscitation — CPR, intubation, defibrillation — regardless of any other advance directive the family has on file.

What the OOH-DNR Covers

Under Texas Health & Safety Code § 166.081, the OOH-DNR instructs emergency medical personnel to withhold:

• Cardiopulmonary resuscitation (CPR)
• Advanced airway management (intubation)
• Artificial ventilation
• Cardiac defibrillation
• Transcutaneous cardiac pacing

It does not prevent EMS from providing comfort care, oxygen, pain management, or other non-resuscitative interventions. Paramedics will still respond, assess, and provide supportive care — they just won't attempt to restart the heart or breathing.

Who Signs It

The OOH-DNR requires three signatures:

1. The patient — or their legal representative (MPOA agent, guardian, or a qualified family member under the surrogate hierarchy)
2. The attending physician — the doctor who is managing the patient's care
3. Two witnesses OR a notary public — witnesses must be competent adults

All three elements must be in place. A form signed only by the patient and family, without the physician's signature, is not legally valid.

The Physical Presence Rule

This is the detail that catches families off guard: the signed OOH-DNR form or a state-approved Texas DNR identification device (bracelet or necklace) must be physically present when EMS arrives. If paramedics can't see or locate the document, they will begin resuscitation.

Practical steps to avoid this:

• Post the form visibly — many families tape it to the refrigerator or inside the front door, which is the first place EMS is trained to check
• Keep a copy in the parent's room if they're in assisted living or a group home
• Consider a DNR ID device — a medical bracelet or necklace that EMS recognizes on sight, available through the patient's physician
• Inform the facility — if your parent is in assisted living, make sure the administrator has the OOH-DNR on file and that staff know where it is

OOH-DNR vs. Other Advance Directives

The OOH-DNR operates independently from other Texas advance directives:

These documents don't conflict — they cover different scenarios. A parent can have all three. The living will guides hospital physicians on ventilators and feeding tubes. The MPOA agent handles day-to-day medical decisions. The OOH-DNR tells paramedics what to do in the first minutes of a home emergency.

Revoking or Changing the OOH-DNR

The patient (or their legal representative) can revoke the OOH-DNR at any time by:

• Destroying the form and any DNR ID devices
• Verbally communicating the revocation to EMS personnel (even during an emergency)
• Executing a written revocation

If the parent's condition or wishes change, the revocation takes effect immediately. There's no waiting period or court process.

Getting the Full Plan in Place

An OOH-DNR is one piece of a broader advance care plan. The Texas Power of Attorney & Guardianship Kit coordinates all four documents — SDPOA, MPOA, Directive to Physicians, and OOH-DNR — into a single execution sequence with checklists for each signing appointment.

See more Texas guides →