Code status form 2026

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4 out of 5

48 votes

The document is a Code Status Form designed for patients to express their wishes regarding resuscitation in advance of an emergency. It outlines options for full resuscitation, do not resuscitate, do not resuscitate with palliative care, and do not intubate. Patients are encouraged to discuss their choices with their doctors and inform family members to alleviate concerns during emergencies.

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Click ‘Get Form’ to open the code status form in the editor.
Begin by reviewing the introduction, which emphasizes the importance of communicating your resuscitation wishes. This sets the context for filling out the form.
In the 'Check the Appropriate Choice' section, select one of the options that best reflects your wishes regarding resuscitation: Full Resuscitation, Do Not Resuscitate, Do Not Resuscitate/Palliative Care, or Do Not Intubate. Make sure to read each option carefully.
If you choose any option other than Full Resuscitation, ensure you understand what treatments may be withheld and what comfort measures will continue.
Sign and date at the bottom of the form to validate your choices. Ensure that both you and your physician or nurse practitioner sign and date where indicated.

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Versions	Form popularity	Fillable & printable
2011	4 Satisfied (48 Votes)

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