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The form directs paramedics and firefighters not to initiate CPR for the patient named, ensuring their comfort instead.
The form must be signed by a qualified healthcare professional such as an M.D., R.N., R.N. (EC), or R.P.N.
Paramedics and firefighters will provide necessary comfort measures, including pain relief and palliative care interventions.
A current treatment plan must exist that reflects the patient's wishes or consent from a substitute decision-maker regarding CPR.
Each form has a unique serial number to ensure proper tracking and documentation.
Photocopies of the completed form are permitted only after it has been fully filled out.