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STATE OF OKLAHOMA
2nd Session of the 58th Legislature (2022)
SENATE BILL 1596 By: Howard
AS INTRODUCED
An Act relating to health care power of attor ney;
creating the Oklahoma Health Care Ag ent Act;
providing short title; defining terms; authorizing
execution of power of attorney for health care;
establishing requirements for execution of power of
attorney for health care; specifying when power of
attorney for health care is effective; es tablishing
requirements for revocation of p ower of attorney for
health care; creating optional form for execution of
power of attorney for health care; authorizing
surrogate to make health care decisions under certain
circumstances; specifying priority of pers ons
eligible to act as surrogate; specifying requirements
for health care provider when class of su rrogates is
in disagreement; providing for disqualification of
surrogate; prohibiting certain persons from serving
as surrogate; requiring complian ce by guardian;
providing exception; requiring certain commu nication
by health care provider; requiring record of certain
information; requiring certain compliance by health
care provider; providing exceptions; requiring noti ce
of certain noncomplian ce; authorizing access to
certain information; establishing immu nity from
liability for certain actions; creating certain
presumption; stating effectiveness of copy;
construing provisions; providing for judicial relief;
requiring retroactive application of provisions to
certain documents; amending 63 O.S. 2021, Sections 1-
1973, 3102.4, 3105.2, 3105.4, 3131.3 and 3131.5,
which relate to the Home Care Act, the Oklahoma
Advance Directive Act , the Physician Orders for Life -
Sustaining Treatment Act, and the Oklahoma Do -Not-
Resuscitate Act; updating statutory references;
providing for codification; and declaring a n
emergency.
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BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new sec tion of law to be codified
in the Oklahoma Statutes as Section 3111.1 of Title 63, unless there
is created a duplication in numb ering, reads as follows:
This act shall be known and may be cited as the “Oklahoma Health
Care Agent Act”.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Se ction 3111.2 of Title 63, unless there
is created a duplication in numb ering, reads as follows:
As used in the Oklahoma Health Care Agent Act:
1. “Advance health care directive” means an individual
instruction to a health care proxy in substantial complia nce with
the Oklahoma Advance Directive Act, Section 3101 et seq. of Title 63
of the Oklahoma Statutes;
2. “Agent” means an individual designated in a power of
attorney for health care to make a health care decision for the
individual granting the power ;
3. “Capacity” means an individual’s ability to understand the
significant benefits, risks, and alternatives to proposed health
care and to make and communicate a health care decision;
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4. “Guardian” means a judicially appointe d guardian or
conservator having authority to make a health care decision for an
individual;
5. “Health care” means any care, treatment, service, or
procedure to maintain, diagnose, or otherwise affect an individual ’s
physical or mental condition;
6. “Health care decision” means a decision made by an
individual or the individual’s agent, guardian, or surrogate,
regarding the individual ’s health care, including:
a. selection and discharge of health care providers and
institutions,
b. approval or disapproval of diagnostic tests, surgical
procedures, programs of medication, and orders not to
resuscitate, and
c. directions to provide, withhold, or withdraw artificial
nutrition and hydration and all other forms of health care , if
nomination is made in compliance with the Oklahoma A dvance Directive
Act;
7. “Health care institution” means an institution, facility, or
agency licensed, certified, or otherwise authorized or permitted by
law to provide health care in the ordinary course of busine ss;
8. “Health care provider” means an individual licensed,
certified, or otherwise authorized or permitted by law to provide
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health care in the o rdinary course of business or practice of a
profession;
9. “Individual instruction ” means an individual’s direction
concerning a health care decision for the individual;
10. “Person” means an individual, corporation, business trust,
estate, trust, partnership, association, joint venture, government,
governmental subdivision, agency, or instrumentality, or any o ther
legal or commercial entity ;
11. “Physician” means an individual authorized to practice
medicine or osteopathy pursuant to Chapter 11 or Chapter 14 of Title
59 of the Oklahoma Statutes ;
12. “Power of attorney for health care ” means the designation
of an agent to make health care decisions for the individual
granting the power;
13. “Primary physician” means a physician designated by an
individual or the individual’s agent, guardian, or surrogate, to
have primary responsibility for the individual ’s health care or, in
the absence of a des ignation or if the designated physician is no t
reasonably available, a physician who undertakes the responsibility ;
14. “Reasonably available ” means readily able to be contacted
without undue effort and willing and able to act in a timely manner
considering the urgency of the patient’s health care needs;
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15. “State” means a State of the United States, the District of
Columbia, the Commonwealth of Pu erto Rico, or a territory or insular
possession subject to the jurisdicti on of the United States ;
16. “Supervising health care provider” means the primary
physician or, if there is no primary physician or the primary
physician is not reasonably availab le, the health care provider who
has undertaken primary responsibility for a n individual’s health
care; and
17. “Surrogate” means an individual, other than a patient’s
agent or guardian, authorized under this act to make a healt h care
decision for the pati ent.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statut es as Section 3111.3 of Title 63, unless there
is created a duplication in numb ering, reads as follows:
A. An adult or emancipated minor may give an oral or written
individual instruction. The instruction may be limited to take
effect only if a specified condition arises.
B. An adult or emancipated minor may execute a power of
attorney for health care, which may authorize the agent to make any
health care decision the pri ncipal could have made while having
capacity. The power shall be in writing and signed by the
principal. The power remains in effect notwithstanding the
principal’s later incapacity and may include individual
instructions. Unless related to the principa l by blood, marriage,
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or adoption, an agent may not be an owner, operator, or employee of
a residential long-term health care institution at which the
principal is receiving care.
C. Unless otherwise specified in a power of attorney for health
care, the authority of an agent becomes effective only upon a
determination that the principal lacks capacity and ceases to be
effective upon a determination that the principal has recovered
capacity.
D. Unless otherwise specified in a power of attorney for health
care, a determination that an individual lacks or has recovered
capacity, or that another cond ition exists that affects an
individual instruction or the authority of an agent, shall be made
by the primary physician.
E. An agent shall make a health care decision in accordance
with the principal’s individual instructions, if any, and other
wishes to the extent known to the agent. Otherwise, the agent shall
make the decision in accordance with the agent ’s determination of
the principal’s best interest. In determining the principal ’s best
interest, the agent shall consider the principal ’s personal values
to the extent known to the agent.
F. A health care decision made by an agent for a principal is
effective without judicial approval.
G. A power of attorney for health care may include the
individual’s nomination of a guardian of the person.
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H. A power of attorney for health care is valid for purposes of
this act if it is in substantial compliance with this act,
regardless of when or where executed or c ommunicated.
SECTION 4. NEW LAW A n ew section of law to be codified
in the Oklahoma Statutes as Section 3111.4 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. An individual may revoke the designation of an agent by a
signed writing or by personally inf orming the supervising health
care provider at any time and in any manner that communicates an
intent to revoke.
B. A health care provider, agent, guardian, or surrogate who is
informed of a revocation shall promptly communicate the fact of the
revocation to the supervising health care provider and to any health
care institution at which the patient is receiving car e.
C. A decree of annulment, divorce, dissolution of marriage, or
legal separation revokes a previous designation of a spouse as agent
unless otherwise specified in the decree or specifically enumerated
in a power of attorney for health care.
D. A power of attorney for health care that conflicts with an
earlier power of attorney for health care revokes the earlier power
of attorney to the extent of the conflict.
SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3111.5 of Title 63, unless there
is created a duplication in numb ering, reads as follows:
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The following form may, but need not, be used to create a power
of attorney for health care. The other sections of this act govern
the effect of this form or any other writing used to create a power
of attorney for health care . An individual may complete or modify
all or any part of the following form:
HEALTH CARE POWER OF ATTORNEY
You have the right to give instructions about your own health
care. You also have the right to name someone else to make health
care decisions for you. This form lets yo u do either or both of
these things. It also lets you expres s your wishes regarding the
designation of your primary physician. If you use this form, you
may complete or modify all or any part of it. You are free to use a
different form.
Part 1 of this form is a power of attorney for health care.
Part 1 lets you name another individual as agent to make health care
decisions for you if you become incapable of making your own
decisions or if you want someone else to make those deci sions for
you now even though you are still capable. You may also name an
alternate agent to act for you if you r first choice is not willing,
able, or reasonably available to make decisions for you. Unless
related to you, your agent may not be an owner, operator, or
employee of a residential long-term health care institution at which
you are receiving care.
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Unless the form you sign limits the authority of your agent,
your agent may make all health care decisions for you. This form
has a place for you to limit the authority of your agent. You need
not limit the authority of your agent i f you wish to rely on your
agent for all health care decisions that may have to be made. If
you choose not to limit the authority of your agent, your agent will
have the right to:
1. consent or refuse consent to any care, treatment, service,
or procedure to maintain, diagnose, or o therwise affect a physical
or mental condition;
2. select or discharge health care providers and institutions;
3. approve or disapprove diagnostic tests, surgical procedures,
programs of medication, and orders not to resuscitate; and
4. direct the provision, withholding, or withdrawal of
artificial nutrition and hydration and all other forms of health
care.
Part 2 of this form lets you designate a physician to have
primary responsibility f or your health care.
After completing this form, sign and date the form at the end.
It is recommended but not required that you request two other
individuals to sign as witnesses. Give a copy of the signed and
completed form to your physician, to any o ther health care providers
you may have, to any health care institution at which you are
receiving care, and to any health care agents you have name d. You
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should talk to the person you have named as agent to make sure that
he or she understands your wishe s and is willing to take the
responsibility.
You have the right to r evoke this power of attorney for health
care or replace this form at any time.
PART 1
POWER OF ATTORNEY FOR HEALTH CARE
1. DESIGNATION OF AGENT: I designate the following individual
as my agent to make health care decisions for me:
______________________ _______________________________ ______________
(name of individual you choose as agent)
___________________________________________________________________
(address) (city) (state) (zip code)
________________________________ ___________________________________
(home phone) (work phone)
OPTIONAL: If I revoke my agent ’s authority or if my agent is
not willing, able, or reasonably availa ble to make a health care
decision for me, I designate as my first alternate agent:
___________________________ ________________________________________
(name of individual you choose as first alternate agent)
_____________________________________________ ______________________
(address) (city) (state) (zip code )
___________________________________________________________________
(home phone) (work phone)
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OPTIONAL: If I revoke the authority of my agent and first
alternate agent or if neither is willing, able, or rea sonably
available to make a health care decision for me, I designate as my
second alternate agent:
___________________________________________________________________
(name of individual you choose as second alternate agent)
___________________________________________________________________
(address) (city) (state) (zip code)
____________________________________________________ _______________
(home phone) (work phone)
2. AGENT’S AUTHORITY: My age nt is authorized to make all
health care decisions for me that I could make if I were able ,
except as I state here:
_________________________________________________________ __________
_______________________________________________ ____________________
______________________________ _____________________________________
(Add additional sheets if needed.)
3. WHEN AGENT’S AUTHORITY BECOMES EFFECTIVE: My agent ’s
authority becomes effective when my primary physician determines
that I am unable to make my own he alth care decisions unless I mark
the following box. If I mark this box [ ], my agent ’s authority
to make health care decisions for me takes effect immediately.
_____________
(Initials)
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4. AGENT’S OBLIGATION: My agent shall make health care
decisions for me in accordance with this power of att orney for
health care and my other wishes to the extent known to my agent. To
the extent my wishes are unknown, my agent sha ll make health care
decisions for me in accordance with what my agent determines t o be
in my best interest. In determining my best interest, my agent
shall consider my personal values to the extent known to my agent.
_____________
(Initials)
5. NOMINATION OF GUARDIAN: If a guardian of my person needs to
be appointed for me by a court, I no minate the agent designated in
this form. If that agent is not willing, able, or reasonably
available to act as guardian, I nominate the alternate agents whom I
have named, in the order designated.
______________
(Initials)
6. RELIEF FROM PAIN: Except a s I state in the following space,
I direct that treatment for alleviation of pain or discomfort be
provided at all times, even if it hastens my death:
_______________________________________________________ _________
________________________________________ ________________________
7. OTHER WISHES: (If you do not agree with any of the optional
choices above and wish to write your own, or if you wish to add to
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the instructions you have given above, you may do so here.) I
direct that:
___________________________________________________________________
___________________________________________________________________
(Add additional sheets if needed.)
PART 2
PRIMARY PHYSICIAN
(OPTIONAL)
8. I designate the following physician as my primary physician:
___________________________________________________________________
(name of physician)
______________________________________________________________ _____
(address) (city) (state) (zip code)
______________________________________ _____________________________
(phone)
OPTIONAL: If the physician I have designated above is not
willing, able, or reasonably available to a ct as my primary
physician, I designate the follo wing physician as my primary
physician:
___________________________ _______________________________ _________
(name of physician)
___________________________________________________________________
(address) (city) (state) (zip code)
__________________________________________________________ _________
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(phone)
9. EFFECT OF COPY: A copy of this form has the same effect as
the original.
10. SIGNATURES: Sign and date the fo rm here:
_______________________________ __________________ ____________
(date) (sign your name)
_______________________________ ______________________________
(address) (print your name)
_______________________________
(city) (state)
(Optional) SIGNATURES OF WITNESSES:
First witness Second witness
______________________________ _______________________________
(print name) (print name)
______________________________ ____ ___________________________
(address) (address)
______________________________ ______________________________
(city) (stat e) (city) (state)
__________________________ ____ ______________________________
(signature of witness) (signature of witness)
______________________________ ______________________________
(date) (date)
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SECTION 6. NEW LAW A new section of law to b e codified
in the Oklahoma Statutes as Section 3111.6 of Title 63, unless there
is created a duplication in numb ering, reads as follows:
A. A surrogate may make a health care decision for a patient
who is an adult or emancipated minor if the patient has been
determined by the primary physician to lack ca pacity and no agent or
guardian has been appointed or the agent or guardian is not
reasonably available.
B. An adult or emancipated minor may designate any individual
to act as surrogate by personally informing t he supervising health
care provider. In t he absence of a designation, or i f the designee
is not reasonably available, any member of the following classes of
the patient’s family who is reasonably ava ilable, in descending
order of priority, may act as surr ogate:
1. The spouse, unless legally sep arated;
2. An adult child;
3. A parent; or
4. An adult sibling.
C. If none of the individuals eligible to act as surrogate
under subsection B of this section is reasonably available, an adult
who has exhibited special care and concern for the patie nt, who is
familiar with the patient’s personal values, and who is reasonably
available may act as surrogate.
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D. A surrogate shall communicate his or her assumpti on of
authority as promptly as practicable to the member s of the patient’s
family specified in subsection B of this section who can be readily
contacted.
E. If more than one member of a c lass assumes authority to act
as surrogate, and they do not agree on a health care decision and
the supervising health care provider is so informed, the superv ising
health care provider shall comply with the decision of a majority of
the members of that cl ass who have communicated their views to the
provider. If the class is evenly divided concerning the health care
decision and the supervising health care provider is so informed,
that class and all individuals having lower priority are
disqualified from making the decision.
F. A surrogate shall make a health care decision in accordance
with the patient’s individual instructio ns, if any, and other wishes
to the extent known to the surrogate. Other wise, the surrogate
shall make the decision in accordance with the surrogate’s
determination of the best interest of the patient. In determining
the best interest of the patient, the surrogate shall consider the
patient’s personal values to the extent known to the surrogate.
G. A health care decision made by a surroga te for a patient is
effective without judicial approval.
H. An individual at any time may disqualify another, includi ng
a member of the individual ’s family, from acting as the individual ’s
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surrogate by a signed writing or by personally informing the
supervising health care provider of the disqualification.
I. Unless related to the patient by blood, marriage, or
adoption, a surrogate may not be an own er, operator, or employee of
a residential long-term health care institution at which the patient
is receiving care.
J. A supervising health care provider may re quire an individual
claiming the right to act as surrogate for a patient to provide a
written declaration under penalty of perjury stating facts and
circumstances reasonably sufficient to estab lish the claimed
authority.
SECTION 7. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3111.7 of Title 63, unless there
is created a duplication in numb ering, reads as follows:
A guardian shall comply with the individual instructions of the
ward and may not revoke the w ard’s power of attorney for health care
unless the appointing court expressly so authorizes.
SECTION 8. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3111.8 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. Before implementing a health care decision made for a
patient, a supervising health care provider, if possible, shall
promptly communicate t o the patient the decision made and the
identity of the person making the decision.
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B. A supervising health care provider who knows of the
existence of an advance health care directive, a power of attorney
for health care, a revocation of either, or a designation or
disqualification of a surrogate, shall promptly record its existence
in the patient’s health care record and, if i t is in writing, shall
request a copy and if on e is furnished shall arrange for its
maintenance in the health care record.
C. A primary physician who makes or is informed of a
determination that a patient lacks or has recovered capacity, or
that another condition exists which affects an individual
instruction or the authority of an agent, guardian, or surrogate,
shall promptly record the determination in the patient ’s health care
record and communicate the determination to the patient, if
possible, and to any person then authorized to make health care
decisions for the patient.
D. Except as provided in subsections E and F of this section, a
health care provider or institution providing car e to a patient
shall:
1. Comply with an individual instruction of t he patient and
with a reasonable interpretation of t hat instruction made by a
person then authorized to make health care decisions for the
patient; and
2. Comply with a health care decision for the patient made by a
person then authorized to make health care decisions for the patient
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to the same extent as if the decision had been made by the patient
while having capacity.
E. A health care provider may decline to comply with an
individual instruction or health care decision for reasons of
conscience. A health care institution may decline to comply wit h an
individual instruction or health care decision if the instruction or
decision is contrary to a policy of the institution which is
expressly based on reasons of conscience and if the policy was
timely communicated to the patient or to a person then aut horized to
make health care decisions for the patient.
F. A health care provider or institution may decline to comply
with an individual instruction or health care decision that requires
medically ineffective health care or health care contrary to
generally accepted health care standards applicable to the health
care provider or institution.
G. A health care provider or institution that declines to
comply with an individual instruction or health care decision shall:
1. Promptly so inform the patie nt, if possible, and any person
then authorized to make health care decisions for the patient;
2. Provide continuing care to the patient unt il a transfer can
be effected; and
3. Unless the patient or person then au thorized to make health
care decisions for the patient refuses assistance, immediately make
all reasonable efforts to a ssist in the transfer of the patient to
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another health care provider or instituti on that is willing to
comply with the instruction or dec ision.
H. A health care provider or institution may not require or
prohibit the execution or revocation of an advance health care
directive as a condition for providing health care.
SECTION 9. NEW LAW A new section of law to be cod ified
in the Oklahoma Statutes as Section 3111.9 of Title 63, unless there
is created a duplication i n numbering, reads as follows:
Unless otherwise specified in a power of attorney for health
care, a person then authorized to make health care decisions for a
patient has the same rights as the patient to request, receiv e,
examine, copy, and consent to the disc losure of medical or any other
health care information.
SECTION 10. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3111.10 of Title 63, unless
there is created a duplication in numb ering, reads as follows:
A. A health care provider or institution acting in good faith
and in accordance with gener ally accepted health care standards
applicable to the health care provider or insti tution is not subject
to civil or criminal liability or to discipline f or unprofessional
conduct for:
1. Complying with a health care decision of a person apparently
having authority to make a health care decision for a patie nt,
including a decision to w ithhold or withdraw health care;
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2. Declining to comply with a he alth care decision of a person
based on a belief that the person then lacked authority; or
3. Complying with a power of attorney for health care and
assuming that the designation was valid when made and has not been
revoked or terminated.
B. An individual acting as agent or surrogate under this act is
not subject to civil or criminal liability or to discipline fo r
unprofessional conduct for health care decisions made in good faith.
SECTION 11. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3111.11 of Title 63, unless
there is created a duplication in numb ering, reads as follows:
A. This act shall not be construed to affect the right of an
individual to make health care decisions while having capacity to do
so.
B. An individual is presumed to have capacity to make a health
care decision, to give or revoke an advance health care directive,
powers of attorney for health care, and to designate or disqualify a
surrogate.
SECTION 12. NEW LAW A n ew section of law to be codified
in the Oklahoma Statutes as Section 3111.12 of Title 63, unless
there is created a duplication in numb ering, reads as follows:
A copy of a written advance health care directive, written power
of attorney for health care, revocation of either, or designation or
disqualification of a surrogate has the s ame effect as the or iginal.
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SECTION 13. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3111.13 of Title 63, unless
there is created a duplication in numb ering, reads as follows:
A. This act does not create a presumption concerning the
intention of an indiv idual who has not made or who has revoked a
power of attorney for health care .
B. Death resulting from the withholding or wi thdrawal of health
care in accordance with this act does not for any purpose constitute
a suicide or homicide or legally impair or invalidate a policy of
insurance or an annuity providing a death benefit, notwithst anding
any term of the policy or annuity t o the contrary.
C. This act shall not be construed to authorize mercy killing,
assisted suicide, euthanasia, or the provision, wit hholding, or
withdrawal of health care, to the extent prohibited by other
statutes of this state.
D. This act shall not be construed to authorize or require a
health care provider or institution to provide healt h care contrary
to generally accepted health care standards applicable to the health
care provider or institution.
E. This act shall not be construed to authorize an agent or
surrogate to consent to the admission of an individual to a mental
health care institution unless the individual’s written directive
expressly so provides.
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F. This act shall not affect other statutes of this state
governing treatment for mental illness of an individual
involuntarily committed to a mental health care institution under
Chapter 1 of Title 43A of the Oklahoma Statutes.
SECTION 14. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3111.14 of Title 63, unless
there is created a duplication in numbering, reads as follows:
On petition of a patient, the patient ’s agent, guardian, or
surrogate, a health care provider or institution involved with the
patient’s care, or an individual described in subsection B or C of
Section 6 of this act, the court may enjoin or direct a health care
decision or order other equitable reli ef. A proceeding under this
section shall be governed by Title 12 of the Oklahoma Statutes.
SECTION 15. NEW LAW A new section of law to be codifie d
in the Oklahoma Statutes as Section 3111.15 of Title 63, unless
there is created a duplication in numbering, reads as follows:
Any document made in substantial compliance with the
requirements of the Oklahoma Health Care Agen t Act on or after
November 1, 2021, shall have full force and effect.
SECTION 16. AMENDATORY 63 O.S. 2021, Section 1-1973, is
amended to read as follows:
Section 1-1973. A. Patients who are capable of self -
administering their own medications without assistance shall be
encouraged and allowed to do so. How ever, a certified nurse aide
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may assist a patient whose condition is medically stable with the
self-administration of routine, regularly scheduled medications that
are intended to be self -administered, if the following conditions
are met:
1. For an oral medication, the medication sh all have been
placed in a medication planner by a registered n urse, a relative of
the patient or nursing staff of an Oklahoma licensed home health or
hospice agency that is currently serving the patient; and
2. For all other fo rms, the certified nurse aid e shall assist
with self-administration consistent with a disp ensed prescription’s
label or the package directions of an over -the-counter medication.
B. For purposes of this section, self -administered medications
include both legend and over-the-counter oral dosage forms, topical
dosage forms and topical ophthalmic, otic and nasal dosage forms,
including solutions, suspensions, sprays and inhalers.
C. Assistance with self -administration of medication by a
certified nurse aide m ay occur only upon a documen ted request by,
and the written informed consent of, a patient or the patient’s
surrogate, guardian or attorney -in-fact.
D. For purposes of this section, assistance with self -
administration of medication includes:
1. Taking an oral medication out of a pi ll planner and bringing
it to the patient;
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2. Placing an oral dosage in the patient ’s hand or placing the
dosage in another container and helping the patient by lifting the
container to his or her mouth;
3. If ordered by a phy sician, placing an oral medi cation in
food before the patient self-administers;
4. Crushing an oral medication pursuant to orders given by a
physician or health care professional;
5. Applying topical medications; and
6. Keeping a record of when a patien t receives assistance with
self-administration pursuant to this section.
E. For purposes of this section, assistance with self -
administration of medication does not include:
1. Removing oral medication from any container other than a
pill planner;
2. Mixing, compounding, convertin g or calculating medication
doses;
3. The preparation of syri nges for injection or the
administration of medications by any injectable route;
4. Administration of medications through intermittent positive
pressure breathing ma chines;
5. Administration o f medications by way of a tube inserted in a
cavity of the body;
6. Administration of parenteral preparations;
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7. Irrigations or debriding agents used in the treatment of a
skin condition;
8. Rectal, urethral, or vaginal prep arations;
9. Medications ordered by the physician or health care
professional with prescr iptive authority to be given “as needed”,
unless the order is written with specific parameters that preclude
independent judgment on the part of the certified nurse a ide, and at
the request of a competent patient;
10. Medications for which the time of adm inistration, the
amount, the strength of dosage, the method of administration or the
reason for administration requires judgment or discretion on the
part of the certified nurse aide; or
11. Assistance with the self-administration of medication by a
certified nurse aide in an assisted living center through home care
services as provided for in Section 1 -890.8 of Title 63 of the
Oklahoma Statutes.
F. Assistance with t he self-administration of me dication by a
certified nurse aide as described in this sectio n does not
constitute administration as defined in Section 353.1 of Title 59 of
the Oklahoma Statutes.
G. The State Commissioner of Health may by rule establish
procedures and interpret terms a s necessary to implement the
provisions of this section.
H. For purposes of this section:
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1. “Informed consent” means advising the patient, or the
patient’s surrogate, guardian or attorney -in-fact, that the patient
may be receiving assistance with self -administration of medication
from a certified nurse aide; and
2. “Attorney-in-fact” means an attorney-in-fact authorized to
act pursuant to the Uniform Durable Power of Attorney Act, Sections
1071 through 1077 of Title 58 of the Oklahoma Statutes Oklahoma
Health Care Agent Act, with authority to act regarding the pat ient’s
health and medical care decisions, subject to the limitations under
paragraph 1 of subsection B of Section 1072.1 of Title 58 of the
Oklahoma Statutes the Oklahoma Health Care Agent Act .
SECTION 17. AMENDATORY 63 O.S. 2021, Section 3102.4, is
amended to read as follows:
Section 3102.4. A. When an adult patient or a person under
eighteen (18) years of age who may consent to have service s provided
by health professionals under Section 2602 of this title is
persistently unconscious, incompetent or otherwise mentally or
physically incapable of comm unicating, a person who is reasonably
available and willing in the following classes, in the o rder of
priority set forth in this subsection, shall be authorized to make
health care decisions for the pati ent under the same standard as
that applicable to mak ing life-sustaining treatment decisions under
Section 3101.16 of this title, excluding any per son who is
disqualified from exercising such authority by Section 3102.5 of
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this title. If those within a cl ass disagree, a majority within the
class may make a health care decision for the patient. However, a
provider of health care to the patient or an y member or members of
any of the following classes may petition a court that would have
jurisdiction over a guardianship proceeding concerning the patient
under Section 1-115 of Title 30 of the Oklahoma Statutes to seek an
order directing a different heal th care decision on the gr ound that
the health care decision or decisions made violate the standard
required by this section, granting another member or other mem bers
from among the following classes (notwithstanding the statutory
order of priority) superv ening authority to make he alth care
decisions for the patient on the ground that clear and convincing
evidence demonstrates they are more likely to adhere to that
standard, or both. Upon motion by any party, the court shall issue
an order requiring that p ending its decision on the merits and the
resolution of any appeal the patient be provided with health care o f
which denial, in reasonable medical judgment, would be likely to
result in or hasten the death of the patient, unless its provision
would require denial of the same health care to another patient.
The classes are as follows:
1. A general guardian of th e person appointed pursuant to
subsection A of Sectio n 3-112 of Title 30 of the Oklahoma Statutes
or a limited guardian of the person appointed pur suant to subsection
B of Section 3-112 of Title 30 of the Oklahoma Statutes with
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authority to make personal m edical decisions as determined under
paragraph 5 of subsection B of Section 3 -113 of Title 30 of the
Oklahoma Statutes;
2. A health care proxy, or alternate health care pro xy,
designated by the patient, as defined in paragraph 6 of Section
3101.3 of Title 63 of the Oklahoma Statutes;
3. An attorney-in-fact authorized to act pursuant to the
Uniform Durable Power of Attorney Act, Sections 1071 throu gh 1077 of
Title 58 of the Oklahoma Statutes Oklahoma Health Care Agent Act,
with authority to act regarding t he patient’s health and medical
care decisions, subje ct to the limitations under paragraph 1 of
subsection B of Section 1072.1 of Title 58 of the Oklahoma Statutes
the Oklahoma Health Care Agent Act;
4. The patient’s spouse;
5. Adult children of the patient;
6. Parents of the patient;
7. Adult siblings;
8. Other adult relatives of the patient in order of kinship; or
9. Close friends of the pat ient who have maintained reg ular
contact with the patient sufficient to be familiar with the
patient’s personal values. Execution of an affidavit stating
specific facts and circumstances documenting such contact
constitutes prima facie evidence of close f riendship.
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B. Prior to making a health care decision for a patient
pursuant to subsection A of this section, a pe rson shall provide to
the health care provider or hea lth care entity a signed copy of the
following statement to be entered into the patient ’s medical record:
“I hereby certify that:
I have not been convicted of, pleaded guilty to or p leaded no
contest to the crimes of abuse, verbal abuse, neglect or financi al
exploitation by a caregiver; exploitation of an elderly person or
disabled adult; or a buse, neglect, exploitation or sexual abuse of a
child;
I have not been found to have committ ed abuse, verbal abus e or
exploitation by a final investigative finding of the State
Department of Health or Department of Human Services or by a finding
of an administrative law judge, unles s it was overturned on appeal;
and
I have not been criminally cha rged as a person resp onsible for
the care of a vulnerable adult with a cri me resulting in the death
or near death of a vulnerable adult. ”
SECTION 18. AMENDATORY 63 O. S. 2021, Section 3105.2, is
amended to read as follows:
Section 3105.2. As used in the Physician Orders for Life -
Sustaining Treatment Act:
1. “Attorney-in-fact” means an attorney-in-fact authorized to
act pursuant to the Uniform Durable Power of Attorney Act, Sections
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1071 through 1077 of Title 58 o f the Oklahoma Statutes Oklahoma
Health Care Agent Act , with authority to act regarding the patient ’s
health and medical care decisions, subject to the limit ations under
paragraph 1 of subsection B of Section 1 072.1 of Title 58 of the
Oklahoma Statutes the Oklahoma Health C are Agent Act;
2. “Guardian” means a general guardian of the person appointed
pursuant to subsection A of Section 3 -112 of Title 30 of the
Oklahoma Statutes or a l imited guardian of the perso n appointed
pursuant to subsection B of Section 3 -112 of Title 30 of the
Oklahoma Statutes with the authority to make personal medical
decisions as determined under paragraph 5 of subsection B of Section
3-113 of Title 30 of the Oklahoma Statutes;
3. “Health care provider” means a person who is licensed,
certified or otherwise authorized by the laws of this state t o
administer health care in the ordinary course of business or
practice of a profession;
4. “Health care proxy” means a health care proxy (or alternate
health care proxy) authorized to act pursuant to the Oklahoma
Advance Directive Act, Sections 3101.1 through 3101.16 of Title 63
of the Oklahoma Statutes this title, as defined in paragraph 6 of
Section 3101.3 of Title 63 of the Oklahoma Statutes this title; and
5. “Other legally authorized person ” means a person, other than
a minor’s custodial parent or g uardian, the patient or the patient ’s
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attorney-in-fact, guardian or health care proxy, who has authority
to make health care decisions for the patient under common law.
SECTION 19. AMENDATORY 63 O.S. 2021, Section 3105.4, is
amended to read as follows:
Section 3105.4. 1. At the top of the first page of the
standardized format Oklahoma physician orde rs for life-sustaining
treatment form the following wording in all capitals shall appear
against a contrasting color backgr ound: “FORM SHALL ACCOMPANY
PERSON WHEN TRANSFERRED OR DISCHARGED”; at the bottom of the first
page the following wording in all cap itals shall appear against a
contrasting color background: “HIPAA PERMITS DISCLOSURE TO HEALTH
CARE PROFESSIONALS AND PROXY DECISION MAKERS AS NECESSARY FOR
TREATMENT”.
2. There shall be an introductory section, the left block of
which shall contain the n ame “Oklahoma Physician Orders for Life-
Sustaining Treatment (POLST) ” followed by the words, “This Physician
Order set is based on the patient’s current medical condition and
wishes and is to be reviewed for potential replacemen t in the case
of a substantial change in either, as well as in other cases listed
under F. Any section not completed indicates full treatment for
that section. Photocopy or fax copy of this form is lega l and
valid.” and the right block of which shall con tain lines for the
patient’s name, the patient’s date of birth and the effective date
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of the form followed by the statement , “Form must be reviewed at
least annually.”
3. In Section A of the form, the le ft block shall contain, in
bold font, “A. Check One”, and the right block shall be headed, in
bold font, “Cardiopulmonary Resuscitation (CPR): Person has no
pulse and is not breathing. ” below which there shall be a checkbox
followed by “Attempt Resuscitation (CPR)”, then a checkbox followed
by “Do Not Attempt Resuscitation (DNR/ no CPR)”, and below which
shall be the words, “When not in cardiopulmonary arrest, follow
orders in B, C and D below. ”
4. In Section B of the form, the left block shall contain, in
bold, “B. Check One”, and the right block shall be headed, in bold,
“Medical Interventions: Person has pulse and/or is breathing. ”
Below this there shall be a checkbox followed by, in bold, “Full
Treatment” followed by, “Includes the use of intubatio n, advanced
airway interventions, mechanical ventila tion, defibrillation or
cardio version as indicated, medical treatment, intravenous fluids,
and cardiac monitor as indicated. Transfer to hospital if
indicated. Include intensive care. Includes treatme nt listed under
“Limited Interventions ” and “Comfort Measures”, followed by, in
bold, “Treatment Goal: Attempt to preserve life by all medically
effective means.”
Below this there shall be a checkbox fo llowed by, in bold,
“Limited Interventions ” followed by, “Includes the use of medical
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treatment, oral and intravenous medications, in travenous fluids,
cardiac monitoring as indicated, noninvasive bi -level positive
airway pressure, a bag valve mask or other advanced airway
interventions. Includes treatment l isted under “Comfort Measures”,
followed by, “Do not use intubation or mechanica l ventilation.
Transfer to hospital if indicated. Avoid intensive care. ” followed
by, in bold, “Treatment Goal: Attempt to preserve life by basic
medical treatments.”
Below this there shall be a checkbox followed by, in bold,
“Comfort Measures only ” followed by, “Includes keeping the patient
clean, warm and dry; use of medication by any route; positioning,
wound care and other measures to relieve pain and suffering. Use
oxygen, suction and manual treatment of airway obstructi on as needed
for comfort. Transfer from current location to intermediate
facility only if needed and adequate to meet comfort needs and to
hospital only if comfort needs cannot otherwise be met in the
patient’s current location (e.g., hip fracture; if int ravenous route
of comfort measures is required).”
Below this there shall be, in italics, “Additional Orders:”
followed by an underlined space for other instructions.
5. In Section C of the form, the left block shall contain, in
bold, “C. Check One” and the right block shall be head ed, in bold,
“Antibiotics”.
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Below this there shall be a checkbox followed by, in bold, “Use
antibiotics to preserve life. ”
Below this there shall be a checkbox followed by, in bold,
“Trial period of antibiotics if and when infec tion occurs.” After
this there shall be, in italics, “*Include goals below in E. ”
Below this there shall be a checkbox followed by, in bold,
“Initially, use antibiotics only to relieve pain and discomfor t.”
After this there shall be, in italics, “+Contact patient or
patient’s representative for further direction.”
Below this there shall be, in italics, “Additional Orders:”
followed by an underlined spac e for other instructions.
6. In Section D of the for m, the left block shall contain, in
bold, “D. Check One in Each Column”, and the right block shall be
headed in bold, “Assisted Nutrition and Hydration ”, below which
shall be “Administer oral fluids and nutrition, if necessary by
spoon feeding, if physica lly possible.” Below these the right block
shall be divided into three columns.
The leftmost column shall be headed, “TPN (Total Parenteral
Nutrition-provision of nutrition into blood vessels). ” Below this
there shall be a checkbox followed by, in bold, “TPN long-term”
followed by “if needed”. Below this there shall be a checkbox
followed by, in bold, “TPN for a trial period* ”. Below this there
shall be a checkbox followed by, in bold, “Initially, no TPN+”.
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The middle column shall be headed “Tube Feeding”. Below this
there shall be a checkbox followed b y, in bold, “Long-term feeding
tube” followed by “if needed”. Below this there shall be a checkbox
followed by, in bold, “Feeding tube for a trial per iod*”. Below
this there shall be a checkbox followed by, in bold, “Initially, no
feeding tube”.
The rightmost column shall be headed , “Intravenous (IV) Fluids
for Hydration”. Below this there shall be a checkbox followed by,
in bold, “Long-term IV fluids” followed by “if needed”. Below this
there shall be a checkbox followed by, in bold, “IV fluids for a
trial period*”. Below this there shall be a checkbox followed by,
in bold, “Initially, no IV fluids+ ”.
Running below all the columns there shall be, in italics,
“Additional Orders:” followed by an underli ned space for other
instructions, followed by, in it alics, “*Include goals below in E.
+Contact patient or patient’s representative for further direction. ”
7. In Section E of the form, the left block sh all contain, in
bold, “E. Check all that apply ” and the right block shall be
headed, in bold, “Patient Preferences as a Basis for th is POLST
Form” shall include the following:
a. below the heading there shall be a box including the
words, in bold, “Patient Goals/Medical Condition:”
followed by an adequate s pace for such information,
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b. below this there shall be a checkbox followed by, “The
patient has an advance directive for health care in
accordance with Sections 3101.4 or 3101.14 of Title 63
of the Oklahoma Statutes.” Below that there shall be
a checkbox followed by, “The patient has a durable
power of attorney for health care decis ions in
accordance with paragraph 1 of subsection B of Section
1072.1 of Title 58 of the Oklahoma Statutes the
Oklahoma Health Care Agent Act.” Below that shall be
the indented words, “Date of execution” followed by an
underlined space. Below that shall be the words, “If
POLST not being executed by patient: We certify that
this POLST is in accordance with the patient ’s advance
directive.” Below this there shall be a n underlined
space underneath which shall be positioned the wo rds,
“Name and Position (pri nt) Signature” and “Signature
of Physician”,
c. below these shall be the words, “Directions given by: ”
and below that a che ckbox followed by “Patient”, a
checkbox followed by “Minor’s custodial parent or
guardian”, a checkbox followed by “Attorney-in-fact”,
a checkbox followed by “Health care proxy”, and a
checkbox followed by “Other legally authorized
person:” followed by an underlined space. Beneath or
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beside the checkbox and “Other legally authorized
person:” and the underlined space shall be the words
“Basis of Authority:” followed by an underlined space,
and
d. below these shall be a four -column table with four
rows. In the top row the first column shall be blank ;
the second column shall have the words, “Printed
Name”; the third column shall have the word,
“Signature”, and the fourth column shall have the
word, “Date”. In the remaining rows the second
through fourth columns shall be blank. In the first
column of these rows, in the second row shall be the
words, “Attending physician”; in the third row shall
be the words, “Patient or other individual checked
above (patient’s representative)”; and in the fourth
row shall be the words, “Health care professional
preparing form (besides doctor).”
8. Section F of the form, which shall have the heading, in
bold, “Information for Patient or Representative of Patient Named on
this Form”, shall include the following language, appea ring in bold
on the form:
“The POLST form is always voluntary and is usually for persons
with advanced illness. Before providing inf ormation for or signing
it, carefully read “Information for Patients and Their Families -
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Your Medical Treatment Rights Und er Oklahoma Law”, which the health
care provider must give you. It is especially important to read the
sections on CPR and food and fluids, which have summaries of
Oklahoma laws that may control the directions you may give. POLST
records your wishes for medical treatment in your current state of
health. Once initial medical treatment is begun and the risks and
benefits of further the rapy are clear, your treatment wishes may
change. Your medical care and this form can be changed to reflect
your new wishes at any time. However, no form can addres s all the
medical treatment decisions that may need to be made . An advance
health care directive is recommended, regardless of your health
status. An advance directive allows you to document in detail your
future health care instructions and/or name a he alth care agent to
speak for you if you are unable to speak fo r yourself.
The State of Oklahoma affirms that the lives of all are of equal
dignity regardless of age or disability and emphasizes that no one
should ever feel pressured to agree to forego life -preserving
medical treatment because of age, disability or fear of being
regarded as a burden.
If this form is for a minor for whom you are authorized to make
health care decisions, you may not direct denial of m edical
treatment in a manner that would vio late the child abuse and neglect
laws of Oklahoma. In particu lar, you may not direct the withholding
of medically indicated treatment from a disabled infant with life -
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threatening conditions, as those terms are de fined in 42 U.S.C.,
Section 5106g or regulations implementing it and 42 U.S.C., Section
5106a.”
9. Section G of the form, which shal l have the heading, in
bold, “Directions for Completing and Implementing Form ”, shall
include the following three subdivisions:
a. the first subdivision, entitled “COMPLETING POLST”,
shall have the following language with the wo rds, “The
signature of the patient or the patient’s
representative is required ” appearing in bold on the
form:
“POLST must be reviewed and prepared in consultation
with the patient or the patien t’s representative after
that person has been given a copy of “Information for
Patients and Their Families - Your Medical Treatment
Rights Under Oklahoma Law ”. POLST must be reviewed
and signed by a physician to be valid. Be sure to
document the basis fo r concluding the patient had or
lacked capacity at the time of execution of the form
in the patient’s medical record. If the patient lacks
capacity, any current advance directive form must be
reviewed and the pat ient’s representative and
physician must both certify that POLST complies with
it. The signature of the patient or the patient ’s
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representative is required; however, if the patient ’s
representative is not reasonably available to sign the
original form, a copy of the completed form with the
signature of the patient’s representative must be
placed in the medical record as soon as practic able
and “on file” must be written on the appropriate
signature line on this form. ”,
b. the second subdivision, entitled “IMPLEMENTING POLST”,
shall have the followin g language:
“If a minor protests a directive to deny the minor
life-preserving medical tre atment, the denial of
treatment may not be implemented pending issuance of a
judicial order resolving the conflict. A heal th care
provider unwilling to comply with P OLST must comply
with the transfer and treatment pending trans fer
requirements of Section 3101.9 of Title 63 of the
Oklahoma Statutes as well as those of the
Nondiscrimination in Treatment Act, Sections 3090.2
and 3090.3 of Title 63 of the Oklahoma Statute s”, and
c. the third subdivision, entitled “REVIEWING POLST”,
shall have the following lan guage:
“This POLST must be reviewed at least annually or
earlier if:
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The patient is admitted to or discharged from a
medical care facility; there is substantial chang e in
the patient’s health status; or the treatment
preferences of the patient or patient ’s representative
change.”
The same requirements for participation of the patient or
patient’s representative, and signature by both a physician and the
patient or the patient’s representative, that are described under
“COMPLETING POLST” shall also apply whe n POLST is reviewed, and must
be documented in Section I.
10. Section H of the form, which shall have the heading, in
bold, “REVOCATION OF POLST”, shall have the fol lowing language, with
the words specified below appearing in b old on the form:
“If POLST is revised or becomes invalid, write in bold the word
“VOID” in large letters on the front of the form. After voiding the
form a new form may be completed. A patient with capacity or the
individual or individuals authorized to sign on behalf of the
patient in Section E of this form may void this form. If no new
form is completed, full treatment and resuscitation is to be
provided, except as otherwise authorized by Ok lahoma law.”
11. Section I of the form, which shall have the heading, in
bold, “REVIEW SECTION”, followed by: “Periodic review confirms
current form or may require completion of new form, ” shall include
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the following columns and a number of rows determine d by the Office
of the Attorney General:
a. Date of Review,
b. Location of Review,
c. Patient or Representative Signature,
d. Physician Signature, and
e. Outcome of Review.
Each row in column (5) shall include a c heckbox followed by,
“FORM CONFIRMED - No Change”, below which there shall be a checkbox
followed by, “FORM VOIDED, see updated form. ”, below which there
shall be a checkbox followed by, “FORM VOIDED, no new form. ”
A final section of the form, which shall have the heading, in
bold, “Contact Information:”, shall include two rows of four
columns. In the first column, the first row shall include
“Patient/Representative” followed by an adequate space for such
information, and the second column shall include “Health Care
Professional Preparing Form ” followed by an adequate space for such
information. In the secon d column both rows shall inc lude
“Relationship” followed by an adequate space for such information;
in the third column both rows shall include “Phone Number” followed
by an adequate space for s uch information; and in the fourth column
both rows shall incl ude “Email Address” followed by an adequate
space for such information.
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SECTION 20. AMENDATORY 63 O.S. 2021, Section 3131.3, is
amended to read as follows:
Section 3131.3. As used in the Oklahoma Do -Not-Resuscitate Act:
1. “Attending physician” means a licensed physician who has
primary responsibility for treatment or care of the person. If more
than one physician s hares that responsibility, any of those
physicians may act as the attending physician under the provisions
of the Oklahoma Do-Not-Resuscitate Act;
2. “Cardiopulmonary resuscitation” means those measures used to
restore or support cardiac or respiratory fu nction in the event of a
cardiac or respiratory arrest;
3. “Do-not-resuscitate identification ” means a standardized
identification necklace, br acelet, or card as set forth in the
Oklahoma Do-Not-Resuscitate Act that signifies that a do -not-
resuscitate consent or order has been executed for the possessor;
4. “Do-not-resuscitate order” means an order issued by a
licensed physician that cardiopulmo nary resuscitation should not be
administered to a particul ar person;
5. “Emergency medical services personnel ” means firefighters,
law enforcement officers, emergency medical technicians, paramedics,
or other emergency service s personnel, providers, or e ntities,
acting within the usual course of their profession s;
6. “Health care decision ” means a decision to giv e, withhold,
or withdraw informed consent to any type of health care including,
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but not limited to, medical and surg ical treatments including li fe-
prolonging interventions, nursing care, hospitalization, treatment
in a nursing home or other extended care f acility, home health care,
and the gift or donation of a body organ or tissue;
7. “Health care agency” means an agency established to
administer or provide health care services and which is commonly
known by a wide variety of titles including, but not lim ited to,
hospitals, medical cen ters, ambulatory health care facilities,
physicians’ offices and clinics, extended ca re facilities operated
in connection with hospitals, nursing homes, extended care
facilities operated in connection with rehabilitation cent ers, home
care agencies and hos pices;
8. “Health care provider ” means any physician, dentist, nurse,
paramedic, psychologist, or other person p roviding medical, dental,
nursing, psychological, hospice, or other health care services of
any kind;
9. “Incapacity” means the inability, bec ause of physical or
mental impairment, to appreciate the nature and implications of a
health care decision, to ma ke an informed choice regarding the
alternatives presented, and to communicate that choice in an
unambiguous manner; and
10. “Representative” means an attorney-in-fact for health care
decisions acting pursuant to the Uniform Durable Power of Attorney
Act Oklahoma Health Care Agent Act, a health care proxy acting
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pursuant to the Oklahoma Rights of the Terminally Ill or
Persistently Unconscious Act, or a guardian of the person appointed
under the Oklahoma Guardianship and Conserva torship Act.
SECTION 21. AMENDATORY 63 O.S. 2021, Section 3131.5, is
amended to read as follows:
Section 3131.5. A. For persons under the care of a health care
agency, a do-not-resuscitate order shall, if issued, be in
accordance with the policies and proce dures of the health care
agency as long as not in conflict with the provisions of t he
Oklahoma Do-Not-Resuscitate Act.
B. The do-not-resuscitate consent form shall be in
substantially the following form:
FRONT PAGE
OKLAHOMA DO-NOT-RESUSCITATE (DNR) CONSEN T FORM
I, _________________________, request limited health care as
described in this document. If my heart stops beating or if I stop
breathing, no medical procedure to restore breathing or heart
function will be instituted by any health care provider in cluding,
but not limited to, emergency medical services (EMS) personnel.
I understand that this decision will not prevent me from
receiving other health care such as the Heimlich maneuver or oxygen
and other comfort care measure s.
I understand that I may r evoke this consent at any time in one
of the following ways:
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1. If I am under the care of a health care agency, by making an
oral, written, or other act of communication to a physician or other
health care provider of a health care agency;
2. If I am not under the care of a health care agency, by
destroying my do-not-resuscitate form, removing all do-not-
resuscitate identification from my person, and notifying my
attending physician of the revocation;
3. If I am incapacitated and under the care of a heal th care
agency, my representative may revoke the do -not-resuscitate consent
by written notification to a physician or other health care provider
of the health care agency or by oral notification to my attending
physician; or
4. If I am incapacitated and n ot under the care of a health
care agency, my representative may revoke the do -not-resuscitate
consent by destroying the do -not-resuscitate form, removing all do -
not-resuscitate identification from my person, and notifying my
attending physician of the rev ocation.
I give permission for this information to be given to EMS
personnel, doctors, nurses, and other health care providers. I
hereby state that I am making an informed decision and agree to a
do-not-resuscitate order.
____________________ OR _________ _______________________
Signature of Person Signature of Representative
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(Limited to an attorney-in-fact for
health care decisions acting under the
Durable Power of Attorney Act Oklahoma
Health Care Agent Act, a health care
proxy acting under the Oklahoma Advance
Directive Act or a guardian of the
person appointed under the Oklahoma
Guardianship and Conservatorship Act .)
This DNR consent form was signed in my
presence.
______________ ______________________ _____________
Date Signature of Witness Addres s
______________________ _____________
Signature of Witness Address
BACK OF PAGE
CERTIFICATION OF PHYSICIAN
(This form is to be used by an attending physician only to
certify that an incapacitated person without a represen tative would
not have consented to the administration of cardiopulmonary
resuscitation in the event of cardiac or respiratory arrest. An
attending physician of an incapacitated person without a
representative must know by clear and convincing evidence tha t the
incapacitated person, when competent, decided on the basis of
information sufficient to constitute informed consent that such
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person would not have consented to the administration of
cardiopulmonary resuscitation in the event of cardiac or respirator y
arrest. Clear and convinc ing evidence for this purpose shall
include oral, written, or other acts of communication between the
patient, when competent, and family members, health care providers,
or others close to the patient with knowledge of the patie nt’s
desires.)
I hereby certify, based on clear and convincing evidence
presented to me, that I believe that ___________________________
Name of Incapacitated Person
would not have consented to the administration of cardiopulmonary
resuscitation in the eve nt of cardiac or respiratory arrest.
Therefore, in the event of cardiac or respiratory arrest, no chest
compressions, artificial ventilation, intubations, defibrillation,
or emergency cardiac medications are to be initiated.
__________________________ _____________________________
Physician’s Signature/Date Physician’s Name (PRINT)
_______________________________________________________________ _
Physician’s Address/Phone
C. Witnesses must be individuals who are eighteen (18) years of
age or older who are not legatees, devisees or he irs at law.
D. It is the intention of the Legislature that the preferred,
but not required, do -not-resuscitate form in Oklahoma shall be the
form set out in subsection B of this section.
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SECTION 22. It being immediately necessary for the p reservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this ac t shall take effect and
be in full force from and after its passage an d approval.
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