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Comprehensive Guide to Do Not Intubate Orders and Advance Healthcare Planning
Navigating Do Not Intubate (DNI) orders can feel overwhelming, especially when medical decisions and legal requirements intersect. This guide explains what a DNI order is, how it functions within California law, and why clear documentation matters for Monterey residents. We describe how DNI orders fit into broader advance healthcare planning alongside living wills and medical powers of attorney. The goal is to provide straightforward information so you can make thoughtful choices about end-of-life care, ensure medical teams understand your wishes, and reduce family uncertainty. If you need help, LA Estate Plans provides practical support for preparing and implementing these directives in Monterey.
A DNI order specifically instructs healthcare providers not to intubate you if you cannot breathe independently, and it often forms part of a larger plan to guide treatment in critical moments. Establishing a DNI involves conversations with clinicians, careful documentation, and attention to California legal requirements so your preferences are honored. For many people in Monterey, a properly executed DNI order offers peace of mind by preserving personal autonomy over invasive breathing interventions. This section outlines the steps to create, store, and communicate your DNI order and practical suggestions for keeping directives up to date as circumstances change.
Why DNI Orders Matter for Your Healthcare Plan
A Do Not Intubate order serves as a direct communication to medical personnel about one specific life-sustaining procedure, preventing unwanted intubation when you cannot state your preferences. The benefit of having a clear DNI order is that it reduces confusion during emergencies and directs clinicians to follow your wishes precisely. Equally important, a DNI order can relieve family members from making high-stakes decisions without knowing your intent. When combined with other advance directives, it becomes part of a cohesive healthcare plan that respects your values and treatment goals while complying with California regulations, preserving dignity and clarity in moments that matter most.
How LA Estate Plans Supports Monterey Residents with DNI Orders
LA Estate Plans assists Monterey clients by explaining the legal framework for DNI orders and helping prepare documents that meet California requirements. Our approach emphasizes clear communication, careful document drafting, and guidance on how to share your directives with medical providers and loved ones. We focus on practical steps such as reviewing form language, ensuring proper signatures, and advising on record placement so your DNI order is accessible when needed. The goal is to help people in Monterey create directives that reflect their wishes and are straightforward for healthcare teams to recognize and follow.
Understanding DNI Orders and How They Function in Practice
A DNI order specifically instructs medical staff not to perform intubation, which involves placing a tube in the airway to assist breathing. This directive is often used by individuals who wish to decline this invasive intervention while possibly accepting other forms of treatment. In California, DNI orders must be documented and included in medical records or presented in a form recognized by treating facilities. For Monterey residents, the process typically begins with conversations with clinicians, followed by written documentation that is clear, signed, and stored where healthcare providers can access it during an emergency.
DNI orders are often paired with broader advance directives such as living wills or medical powers of attorney to create a full picture of treatment preferences. A living will can outline preferences for multiple life-sustaining treatments while a medical power of attorney names someone to make decisions on your behalf if you are incapacitated. Together, these documents help ensure consistency between your expressed wishes and the actions taken by clinicians in Monterey hospitals and care settings. Regular review and clear communication with appointed decision-makers are important to maintain alignment between documents and current preferences.
Defining a Do Not Intubate Order and Its Legal Role
A Do Not Intubate order is a focused medical directive directing clinicians not to place a breathing tube if you cannot breathe on your own. In California, this order must be documented properly and included in your medical record to be effective. The DNI clarifies a single intervention, distinguishing it from broader directives that may cover multiple treatments. Understanding the precise legal and medical implications helps you decide whether a DNI alone is appropriate or whether it should be combined with other advance care documents to reflect your overall preferences and ensure coordinated care across providers in Monterey.
Key Steps to Establishing and Maintaining a DNI Order
Creating a valid DNI order typically involves discussing your wishes with a healthcare provider, documenting your decision in writing, and ensuring the signed order is placed in your medical record. Additional steps include appointing a healthcare proxy to represent your wishes if you cannot speak for yourself, sharing copies with family and providers, and reviewing the directive periodically for changes. In California, attention to signature and witness requirements, form clarity, and proper filing in clinical records helps ensure the DNI order will be recognized by medical teams during emergencies in Monterey and surrounding care settings.
Glossary: Common Terms Related to DNI Orders
Familiarity with common terms improves communication with clinicians and makes advance planning more effective. This glossary covers words frequently used in healthcare directives, such as DNI, advance healthcare directive, intubation, and healthcare proxy, and explains their practical significance in medical decision-making. Understanding these terms helps you complete accurate documentation, know what questions to ask providers, and ensure your designated decision-maker can act consistently with your wishes. Clear terminology reduces misinterpretation and supports smoother implementation of your healthcare preferences within Monterey medical facilities.
Do Not Intubate (DNI)
A Do Not Intubate order is a medical instruction to withhold intubation and mechanical ventilation if the patient cannot breathe independently. It addresses one specific intervention and is often used to prevent invasive airway management that the patient does not want. When documented according to California standards and placed in medical records, a DNI order directs clinical staff to follow the patient’s wishes during respiratory emergencies. Clear language and accessible documentation help ensure that the order is respected by providers in hospitals, urgent care settings, and long-term care facilities in Monterey.
Advance Healthcare Directive
An advance healthcare directive is a legal document that outlines a person’s preferences for medical treatment if they become unable to make decisions. It commonly includes treatment preferences, wishes for life-sustaining care, and the appointment of a healthcare proxy. An advance directive can incorporate or reference a DNI order as part of a broader plan. Ensuring that the directive is signed, stored in medical records, and communicated to loved ones helps guarantee that healthcare providers in Monterey can access and follow those preferences when needed.
Intubation
Intubation is a medical procedure in which a tube is placed into the airway to assist breathing, often connected to mechanical ventilation. It is used in emergencies and during critical care when a patient cannot maintain adequate respiration on their own. Understanding what intubation involves helps individuals decide whether to include a DNI order among their advance directives. Clear documentation of a refusal of intubation informs clinical teams that the patient prefers non-intubation approaches or palliative measures consistent with their goals of care in Monterey medical settings.
Healthcare Proxy (Medical Power of Attorney)
A healthcare proxy or medical power of attorney is a person authorized to make medical decisions on behalf of someone who lacks capacity. Designating a trusted proxy ensures your documented preferences, including a DNI order, are advocated for when you cannot speak. The proxy is responsible for interpreting written directives and communicating your wishes to healthcare teams. Selecting and informing an appropriate proxy, and providing them with copies of your DNI order and advance directive, improves the likelihood that your treatment preferences will be followed in Monterey hospitals and care facilities.
Comparing DNI Orders, Living Wills, and Medical Powers of Attorney
There are several legal tools for expressing medical preferences: a DNI order focuses on intubation, a living will outlines broader treatment wishes, and a medical power of attorney designates a decision-maker. Each option serves a different role: the DNI provides a specific instruction for airway management, the living will offers instructions for a range of interventions, and the agent named under a medical power of attorney can make situational judgments. Understanding how these documents complement one another helps Monterey residents assemble a clear and practical advance care plan that aligns with personal values and clinical realities.
When a Focused DNI Order May Be Appropriate:
Specific Intent to Refuse Intubation
A limited approach that centers on a DNI order works well when your primary concern is refusing intubation while leaving other treatments available. If you want to avoid invasive airway management but are comfortable receiving oxygen, antibiotics, or other measures, a DNI order gives precise direction to clinicians. This focused directive reduces ambiguity in emergency settings and allows medical teams to respond with non-intubation care options that honor your preferences. For many Monterey residents, this clarity is the main goal and can be achieved without broader directives when circumstances and values are specific.
Preference for Simplicity and Quick Recognition
Some people prefer a straightforward DNI order because it is simple for clinicians to identify and implement during urgent care. In high-pressure scenarios, a concise, well-documented order can be recognized quickly in a medical chart or on an emergency form, minimizing uncertainty. This practical clarity is particularly valuable when rapid respiratory decisions are required. For Monterey residents who want one clear instruction rather than multifaceted directives, a focused DNI can reduce delays and ensure that treating teams act in alignment with the patient’s stated preference about intubation.
Why Integrating DNI Orders Into a Comprehensive Advance Care Plan Matters:
Addressing Multiple Treatment Scenarios
A comprehensive approach is important when you want to express preferences across a range of treatments and possible medical scenarios. Combining a DNI order with a living will and a medical power of attorney ensures your desires about intubation are consistent with your broader wishes for life-sustaining care. This prevents conflicts between documents and provides detailed guidance to clinicians and decision-makers. For Monterey residents with complex health conditions or varied treatment priorities, an integrated plan helps align clinical decisions with personal goals and reduces the risk of confusion during critical care episodes.
Reducing Family Disputes and Providing Clear Direction
Comprehensive documents can reduce disputes among family members by recording explicit preferences and naming a trusted decision-maker to carry out those wishes. When a DNI order is part of a broader advance directive package, there is less room for misinterpretation or disagreement about the intended care plan. Documented clarity supports smoother conversations and more predictable outcomes when loved ones and clinicians must act quickly. In Monterey, having fully coordinated directives helps ensure that personal preferences are understood and followed, easing the burden on family members during stressful moments.
Advantages of Building a Complete Advance Healthcare Plan
Creating a comprehensive advance healthcare strategy that includes a DNI order, living will, and healthcare proxy provides a robust framework for ensuring your wishes are followed. This approach minimizes ambiguity, aligns medical teams and family members, and covers multiple potential treatment decisions beyond intubation. A cohesive plan supports consistent decision-making across hospitals, clinics, and long-term care facilities in Monterey, reducing the likelihood of conflicting instructions and improving coordination of treatment according to your values and goals.
Comprehensive planning also promotes ongoing review and revision, encouraging you to revisit directives as health or personal preferences change. This proactive maintenance ensures documents remain current and reflective of your goals. When healthcare providers and appointed decision-makers have access to clear, updated directives, they can make informed choices that honor your intent. For families, a comprehensive plan provides reassurance that decisions will follow documented wishes, helping preserve dignity and reduce emotional strain during medical crises in Monterey.
Greater Consistency Across Care Settings
A comprehensive set of documents creates consistency when you receive care from different providers or move between facilities. By combining a DNI order with other directives and ensuring copies are available in medical records, you reduce the risk of contradictory instructions or delays in honoring your preferences. This consistency supports continuity of care for Monterey residents, making it more likely that clinicians will follow the plan you intended and that appointed decision-makers will have the legal tools they need to advocate effectively on your behalf.
Improved Communication and Reduced Family Stress
When your directives are clear and comprehensive, communication with family members and healthcare providers becomes simpler and less contentious. Well-drafted documents reduce the burden on loved ones who might otherwise need to guess your wishes, and they provide clear authority for those appointed to make decisions. This clarity can prevent disputes and allow families in Monterey to focus on comfort, support, and emotional needs rather than legal ambiguity during difficult medical situations.
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Practical Tips for Managing Your DNI Order
Discuss Your Wishes Clearly with Providers
Talk openly with your primary care physician and any treating specialists about whether a DNI order reflects your goals for care. Clear conversations make it easier for clinicians to document your preferences in the medical record and advise on how a DNI integrates with other directives. In Monterey, notifying clinic staff and hospital teams ensures that your decision is visible at the point of care. Communicating with family members and the person you appoint as healthcare proxy reduces the risk of misunderstandings and helps ensure everyone knows how to honor your choices.
Keep Documents Accessible and Share Copies
Review and Update Regularly
Review your DNI order and other directives periodically or when your health or personal preferences change. Regular updates ensure that documents reflect current wishes and prevent ambiguity. Whenever you revise a DNI order, inform your healthcare providers and the person you appointed as proxy so they have the latest version. Maintaining up-to-date documentation is especially important when relocating care providers, changing medical facilities, or after major life events that alter your treatment goals or priorities.
Reasons Monterey Residents Should Consider a DNI Order
A DNI order is a way to retain personal control over the use of invasive airway management and ensures that, in an emergency, clinicians have explicit instructions about your preferences. For people with progressive illnesses, chronic conditions, or concerns about invasive interventions, a DNI order provides a clear statement to healthcare teams. It also helps prevent family members from facing uncertain, high-pressure decisions without guidance, promoting treatment that aligns with your values and priorities while reducing emotional stress during critical medical events in Monterey.
Establishing a DNI order can be part of broader planning that preserves dignity and comfort-focused care goals. Whether you are planning for advanced stages of illness, preparing for surgery, or simply documenting preferences in case of unexpected emergencies, a DNI order ensures your breathing-related wishes are known and respected. This directive also complements other documents, such as a living will or medical power of attorney, offering a layered approach that supports both legal clarity and compassionate decision-making for Monterey families.
Common Situations When a DNI Order Is Considered
People typically consider a DNI order in contexts such as terminal illness, advanced chronic disease, or advanced age when intubation would not support meaningful recovery or would conflict with quality-of-life goals. It is also relevant for those who prioritize comfort care or wish to limit certain aggressive interventions. In each situation, the DNI order clarifies your intent regarding intubation while allowing you to accept other appropriate forms of medical care. Clear documentation helps medical teams and families follow treatment aligned with your values in Monterey.
Terminal Illness and Comfort-Focused Care
Individuals with terminal illnesses often choose a DNI order to focus on comfort-oriented care rather than invasive interventions that may prolong the dying process. A DNI can help direct clinicians to prioritize symptom management, pain control, and quality of life. Documenting these preferences clearly in medical records and sharing them with family and providers reduces uncertainty during acute episodes and supports treatment consistent with the patient’s values and goals in Monterey healthcare settings.
Chronic Conditions with Limited Recovery Potential
People with chronic conditions that have limited prospects for recovery may opt for a DNI order to avoid invasive respiratory support that could lead to prolonged hospitalization without meaningful improvement. A DNI clarifies that intubation should not be pursued while allowing for other medical interventions focused on comfort or symptom relief. Including the DNI in a comprehensive directive package ensures that treating clinicians and the appointed decision-maker understand the broader context of the patient’s healthcare goals in Monterey.
Advanced Age and Prioritizing Quality of Life
Older adults sometimes choose a DNI order as part of an overall plan to prioritize quality of life over aggressive interventions. Age-related frailty and coexisting medical issues can make intubation less desirable, and a DNI helps ensure that breathing interventions align with personal goals for comfort and dignity. Clear documentation, communication with family, and coordination with healthcare providers help preserve the individual’s wishes across care settings in Monterey.
We Are Here to Help Monterey Residents with DNI Orders
Why Monterey Residents Choose LA Estate Plans for DNI Orders
Clients come to LA Estate Plans for assistance with DNI orders because we focus on clear documentation and practical implementation within California’s legal framework. Our approach emphasizes careful drafting and thoughtful communication so your instructions are easy for clinicians to follow. We also advise on how to integrate DNI orders into broader advance directive packages, helping ensure consistency across documents and settings. The result is a set of directives that accurately reflect your wishes and are positioned to be effective when needed.
We guide clients through the administrative steps that ensure directives are recognized by healthcare providers, including placement in medical records, distribution of copies to key individuals, and review of signature requirements. This practical support reduces the risk of administrative issues that might otherwise limit the DNI order’s effectiveness. By preparing clear documents and advising on storage and sharing, we help Monterey residents maximize the likelihood that their breathing-related preferences will be honored in clinical situations.
Our team also helps clients consider how a DNI order relates to other planning documents and how to communicate choices to family members and appointed decision-makers. We encourage regular review and provide recommendations for updating documents when circumstances change. This ongoing attention to clarity and accessibility helps sustain the effectiveness of your directives and supports smoother decision-making by loved ones and healthcare teams in Monterey during critical moments.
Contact LA Estate Plans to Discuss Your DNI Order
How We Handle the Legal Process for DNI Orders
Our process for DNI orders includes an initial discussion to understand your treatment preferences, drafting clear and compliant documents, and advising on execution and distribution. We ensure that the DNI order language is unambiguous and that required signatures are obtained. We also provide recommendations for storing the document in medical records and sharing it with your healthcare proxy and family. This practical framework supports recognition of your wishes by treatment teams in Monterey and helps reduce the chance of administrative or interpretive challenges during emergencies.
Step One: Initial Consultation and Needs Assessment
The first step involves discussing your healthcare values and how a DNI order fits into your overall plan. We ask about medical conditions, treatment goals, and who you would like to appoint as a decision-maker. This conversation helps determine whether a DNI alone is suitable or whether additional documents are advisable. We also explain California-specific legal considerations and document options so you can make informed choices. The objective is to create a directive that reflects your wishes and works effectively across clinical settings in Monterey.
Discussing Treatment Preferences
During this phase, we explore your views on intubation and other life-sustaining treatments, discuss potential medical scenarios, and clarify priorities such as comfort care versus life-prolonging measures. These conversations help shape precise directive language and ensure that the DNI order is consistent with your broader goals for care. Clear discussion with clinicians and the appointed decision-maker supports better alignment between written documents and real-world medical decisions in Monterey facilities.
Selecting a Healthcare Proxy and Communication Plan
We help you choose and notify an appropriate healthcare proxy who will advocate for your wishes if you cannot speak for yourself. This includes guidance on discussing your preferences with that person and providing them with copies of your DNI order and related directives. Preparing your proxy ensures that, in an emergency, someone familiar with your intentions can communicate effectively with medical staff and ensure your DNI order is followed in Monterey hospitals and care settings.
Step Two: Document Preparation and Review
In the document preparation stage, we draft clear, legally sound DNI orders and any accompanying advance directives that support your goals of care. Attention is given to language clarity, signature requirements, and instructions for placement in medical records. We also review drafts with you so you can request revisions and confirm that the documents reflect your preferences precisely. Proper preparation increases the likelihood that medical teams in Monterey will recognize and implement the DNI order when necessary.
Drafting Clear DNI Language
Drafting focuses on precise phrasing that instructs clinicians not to intubate while avoiding ambiguous terms that could be misinterpreted. We ensure the DNI order is consistent with California documentation practices and that it aligns with any living will or other directives you choose to include. Clear drafting makes it easier for hospital staff and emergency clinicians to locate and apply the order in urgent situations.
Client Review and Finalization
You will have the opportunity to review the finalized documents and request changes to reflect your preferences. We check signature, witness, or notarization requirements and provide guidance on how to record the DNI order in medical charts. Finalization includes discussing where to store documents and who should receive copies so the directive is available when needed in Monterey medical settings.
Step Three: Execution, Distribution, and Ongoing Maintenance
After finalizing the documents, we assist with signing and any required formalities, and advise on distributing copies to healthcare providers, the appointed proxy, and family members. We also recommend procedures for placing the DNI order in your medical record and keeping accessible copies. Ongoing maintenance includes periodic review and updates when health or personal preferences change, ensuring that the DNI order remains current and effective across care transitions in Monterey.
Execution and Placement in Medical Records
Execution involves following the formal requirements for valid documentation, including signatures and witness steps when applicable, and ensuring the directive is included in your electronic or paper medical record. We advise how to present the DNI order to clinic staff and hospitals so it can be easily found and honored. Proper placement in records is essential for the order to be actionable by medical teams in Monterey emergency and inpatient settings.
Distribution to Loved Ones and Providers
We recommend distributing copies to your healthcare proxy, family members, and primary care providers. Informing those close to you about the existence and location of the DNI order helps ensure swift access during emergencies. Keeping an accessible copy and instructing your primary care physician to include the order in your chart increases the likelihood that treating teams will follow your wishes in Monterey hospitals and urgent care centers.
The Proof is in Our Performance
Frequently Asked Questions About DNI Orders in Monterey
What is a Do Not Intubate (DNI) order?
A Do Not Intubate order is a medical instruction indicating that the patient does not want intubation or mechanical ventilation if they cannot breathe independently. It is specific to airway management and typically addresses only that one intervention, clarifying to clinicians that they should withhold intubation under the circumstances described in the order. Proper documentation of a DNI order in a medical record helps ensure that treating teams understand and can honor the patient’s instruction during respiratory emergencies. A valid DNI order should be clearly written, signed, and placed in your medical records so caregivers can access it quickly. Discussing the order with your healthcare provider and your designated decision-maker helps ensure everyone understands your intent. Including the DNI order as part of a larger advance care plan can improve consistency across medical decisions and provide broader guidance for clinicians and loved ones.
How do I establish a DNI order in Monterey, California?
To establish a DNI order in Monterey, begin by discussing your wishes with a trusted healthcare provider who can help document the instruction in your medical record. The provider can place an order on your chart or assist with completing forms that are recognized by local hospitals. Clear, written documentation and proper signatures are important to ensure the order is actionable during emergencies. It is also advisable to inform your family and the person you appoint as healthcare proxy, providing them with copies and guidance on where the documents are kept. Ensuring the DNI order is included in electronic or paper medical records and accessible to treatment teams increases the likelihood it will be followed when needed.
Can I change or revoke a DNI order after it is created?
Yes, you can change or revoke a DNI order at any time as long as you are mentally competent to make that decision. To make a revocation effective, inform your healthcare provider, request the order be removed from your medical record or replaced with updated documentation, and provide written confirmation of the change. Communicating these changes promptly to family and your healthcare proxy helps avoid confusion during urgent situations. If you update or revoke a DNI order, be sure to replace copies held by loved ones and instruct your medical providers to note the change in your chart. Regular review and confirmation of current directives ensure your medical care continues to reflect your wishes.
How does a DNI order differ from a living will?
A DNI order specifically addresses a single intervention: intubation and mechanical ventilation. A living will is broader and can express preferences for multiple life-sustaining treatments, such as resuscitation, tube feeding, and other interventions. While a DNI focuses narrowly on airway management, a living will provides wider context for how you wish to be treated in various medical situations. Both documents can work together to provide clearer guidance to clinicians and family members. Including both a DNI order and a living will in your advance planning helps ensure consistency and reduces the chance of conflicting instructions when critical decisions must be made.
Who enforces a DNI order if I cannot communicate my wishes?
If you cannot communicate, the healthcare team will follow your documented DNI order and consult the designated healthcare proxy if there are questions about interpretation or related care decisions. The appointed proxy serves to advocate for your wishes and to make decisions that align with your documented preferences if any situation falls outside the scope of the DNI order. It is important to appoint a proxy you trust and to inform them of your wishes so they can represent your intent confidently. Providing your proxy and key family members with copies of the DNI order helps ensure swift and accurate implementation by local medical staff.
Is a DNI order legally binding in California?
Yes, a DNI order is legally effective in California when it is properly documented and included in the patient’s medical records. Healthcare providers are expected to follow a valid DNI order and withhold intubation as instructed. Ensuring the order meets documentation and signature requirements increases the likelihood it will be recognized and followed by treating teams. To help guarantee legal effectiveness, confirm with your provider that the DNI order is entered into your chart and accessible during emergencies. Clear language and proper filing in medical records are key to ensuring the order is acted upon by clinicians in Monterey.
Can family members override a DNI order?
When a DNI order is valid and properly recorded, it generally cannot be overridden by family members, as it represents the patient’s expressed medical wishes. Medical personnel are bound to follow documented directives that meet legal requirements. Clear documentation and accessible records strengthen the enforceability of your decisions and reduce the likelihood of disputes among family members. However, communication is important: informing family and your healthcare proxy about the existence and location of the DNI order reduces conflict and ensures everyone understands your choices. If disagreements arise, having well-documented directives helps guide clinicians and appointed decision-makers toward honoring the patient’s wishes.
Should a DNI order be part of a larger advance care plan?
A DNI order can be an effective and focused tool, but integrating it into a broader advance care plan often provides better protection and clarity. Combining a DNI with a living will and a medical power of attorney offers comprehensive guidance covering many types of treatment decisions and designates someone to advocate for your wishes if situations fall outside the DNI’s scope. A coordinated package of documents minimizes the chance of conflicting instructions and helps medical teams and families respond consistently. For many Monterey residents, a combined approach ensures treatment aligns with overall values and reduces uncertainty during critical care situations.
Where should I keep my DNI order so it will be found in an emergency?
Keep your DNI order in a place where medical staff and loved ones can find it quickly in an emergency. Recommended options include placing a copy in your electronic health record, keeping a paper copy in an accessible home file, and providing copies to your primary care provider, specialists, and the person you appoint as healthcare proxy. Let family members know where the documents are stored so they can retrieve them if needed. You may also carry a short card indicating the existence of advance directives and where the full documents are located. Ensuring multiple trusted people and healthcare locations have copies increases the likelihood that treating teams in Monterey will locate and honor your DNI order promptly.
Do hospitals in Monterey recognize DNI orders from other states?
Hospitals in Monterey generally recognize valid DNI orders from other states, but recognition can depend on the formality and clarity of the documentation. To reduce potential issues, it is helpful to have directives that are clearly written, signed, and accompanied by supporting advance directive language or a medical power of attorney. When traveling or relocating, consider updating or re-executing documents to reflect California practices and hospital expectations. If you have out-of-state directives, inform your current providers and ensure copies are placed in your local medical records. Taking steps to confirm recognition by Monterey facilities helps increase the effectiveness of the DNI order when care is needed locally.