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Arizona do not resuscitate form

Arizona do not resuscitate form 2025

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The document is a Prehospital Medical Care Directive (DNR) for the state of Arizona, which allows individuals to refuse 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. The directive ensures that while resuscitation efforts are not performed, comfort care will still be provided. Additional personal information and signatures from witnesses and healthcare providers are also required.

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Click ‘Get Form’ to open the Arizona Do Not Resuscitate form in our editor.
Begin by filling out the 'My Directive and My Signature' section. Clearly indicate your refusal of resuscitation measures by signing and dating the form.
Provide your personal information, including your date of birth, sex, race, eye color, and hair color. This information is crucial for identification purposes.
If you prefer, attach a recent photograph in the designated area on the form.
Next, complete the section regarding your doctor or hospice program. Include your physician's name and telephone number, as well as any hospice program details if applicable.
Ensure that your healthcare provider signs and dates the form after explaining its implications to you.
Finally, have a witness sign the document to confirm they were present when you signed it and that you appeared to be of sound mind.

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Who can witness a DNR in AZ?

Please note that the witness must be at least 18 years of age, cannot be family member (related by blood, adoption or marriage), cannot be in your will to receive part of your estate, cannot be appointed as your representative and cannot be one of your healthcare providers.

Do DNRs expire in Arizona?

Advance directive documents do not have an expiration date. An in-hospital DNR document or medical order that is used during a hospital stay may expire, but those are not considered advance directives in Arizona, but instead are considered medical orders, so they are not accepted into the AzHDR.

How to write a do not resuscitate letter?

How To Write a DNR Form Write the name of the patient and then state where you or that person lives. Make sure to make the requests known, that CPR, or another treatment, is to be withheld. Acknowledgment: The people who are in charge of the patient must sign the document.

Who can docHub a DNR?

Qualified Witnesses: Both witnesses must be competent adults, who have witnessed the competent adult person making his/her signature in section A, or persons authorized representatives making his/her signature in either Sections B, C, or E on the OOH-DNR Order, or if applicable, have witnessed the competent adult

What is the DNR law in Arizona?

Before it is legally binding, in most states the DNR must be signed by a physician as well as docHubd by a notary public. Once these steps are completed, your document is recognized by the state.

Does Arizona have a polst form?

The right documentation: the Arizona POLST form will be carefully and correctly completed along with their living will and healthcare power of attorney, submitted to the Arizona Directory, and available to those who will need to locate and honor the Arizona POLST orders across the continuum of care.

Arizona do not resuscitate form 2025

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Arizona do not resuscitate form 2025

Here's how it works

How to use or fill out Arizona Do Not Resuscitate Form with DocHub

Complete this form in 5 minutes or less

Got questions?

Who can witness a DNR in AZ?

Do DNRs expire in Arizona?

How to write a do not resuscitate letter?

Who can docHub a DNR?

What is the DNR law in Arizona?

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People also ask

Does Arizona have a polst form?

Related links

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