Arizona Prehospital Medical Care Directive - Do Not Resuscitate Order - Arizona 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name in the 'Patient' field, followed by the date of signing. This identifies you as the individual making this directive.
  3. Attach a recent photograph or provide your date of birth, sex, eye color, hair color, and race in the designated fields. This information helps verify your identity.
  4. If applicable, indicate your hospice program by filling in that section. This ensures that your care preferences are known to all involved parties.
  5. Next, enter the name and telephone number of your physician. This allows emergency personnel to contact your doctor for further instructions if needed.
  6. A licensed health care provider must sign and date the form after explaining its implications to you. Ensure they complete this step for validity.
  7. Finally, a witness must sign and date the document confirming they were present when you signed it and that you appeared sound of mind.

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The Prehospital Do Not Resuscitate (DNR) Form has been developed by the California Emergency Medical Services Authority, in concert with the California Medical Association and emergency medical services (EMS) providers, for the purpose of instructing EMS personnel regarding a patients decision to forego resuscitative
Does my advance directive include my wishes about organ donation, cremation or burial? Some states may include your wishes about whether you want to be an organ donor as part of the advance directive. If it is not included, you can still write down your decision about organ donation.
The requirements for creating a DNR vary from state to state. In California, a DNR order must include the patients name and the date of the order, and must be signed by you (or your healthcare agent) and your physician. The DNR will be entered into your medical records.
Prehospital Medical Care Directives (Do Not Resuscitate) o This form needs to be on orange paper and should be signed by you and your doctor. It informs emergency medical technicians (EMTs) or first responders not to resuscitate you. Sometimes this is called a DNR Do Not Resuscitate.
You dont need to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. To establish DNR or DNI orders, tell your doctor about your preferences. He or she will write the orders and put them in your medical record.

People also ask

Unlike other states, Arizona does not require the signature of the persons attending physician on a DNR form. Any licensed healthcare provider can sign the form if they acknowledge that they have advised the person that the withholding of cardiopulmonary resuscitation efforts could result in death.
The DNR must be signed by the patient or by the patients legally recognized health care decision maker if the patient is unable to make or communicate informed health care decisions.

prehospital medical care directive