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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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