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The document is a Prehospital Medical Care Directive, commonly known as a Do Not Resuscitate (DNR) order, which instructs emergency medical personnel not to perform resuscitation measures in the event of cardiac or respiratory arrest. It must be signed by the patient and their doctor, and it requires specific formatting on orange paper to be valid under Arizona law. The document includes sections for personal information, physician details, and signatures from both the healthcare provider and a witness.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'My Directive and My Signature' section. Clearly state your refusal of resuscitation measures and provide your signature along with the date and printed name.
Next, complete the personal information fields. You can either attach a recent photograph or fill in details such as your date of birth, sex, race, eye color, and hair color.
In the 'Information About My Doctor and Hospice' section, enter your physician's name and telephone number. If applicable, include the name of your hospice program.
Ensure that a licensed health care provider signs the form, confirming they have explained its implications to you.
Finally, have at least one adult witness sign the document. Ensure that this person meets all legal requirements outlined in the instructions.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (130 Votes)
2016	4.3 Satisfied (45 Votes)

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What are the steps to get a DNR?

How is a DNR Order Created? If you decide you want a DNR order, tell your provider and health care team what you want. Your provider must follow your wishes, or: Your provider may transfer your care to a provider who will carry out your wishes.

How to complete a do not resuscitate form?

Most DNR forms do not need to be docHubd, although they can be. Typically, two adult witnesses are required to watch you sign the order, and then add their own signatures to attest that you were sound of mind. However, you can replace these two witness signatures by having your DNR Form signed by a notary.

How to create a do not resuscitate?

You can use an advance directive form or tell your doctor that you dont want to be resuscitated. Your doctor will put the DNR order in your medical chart. Doctors and hospitals in all states accept DNR orders. They do not have to be part of a living will or other advance directive.

What is a DNR file?

A do-not-resuscitate order (DNR) is a set of instructions that tell your healthcare team what kind of care you do and dont want at the end of your life. This is a legal and medical document, and it ensures that your end-of-life medical care aligns with your beliefs, needs and desires as closely as possible.

What is needed for a DNR order to be valid?

How to fill out the Do Not Resuscitate Order Form Instructions? Gather all necessary patient information. Complete the form with accurate medical details. Obtain the required consents as per state laws. Have the form signed by the attending physician. Deliver the completed form to the appropriate medical personnel.

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How do you do a DNR form?

How to get a DNR (do not resuscitate) form. If you want to refuse CPR, you should ask your GP or the doctor in charge of your care to record this decision in a DNR form. You can only get a DNR form from your doctor.

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