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The document is a Prehospital Medical Care Directive, also 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 background 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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What do you need for a DNR in Arizona?

36-3251. The DNR must also be signed and dated, and must include either a recent photograph or a detailed description of the signer. The language on the backside of the DNR must also comply with A.R.S. 36-3251, and must be signed by a licensed health care provider and a witness.

Can you get a DNR without a doctor?

In most cases, a DNR must be signed by the patient and the attending physician. In the case that the patient is incapacitated, the DNR can be signed by their legally authorized health care agent. Some states also require that the DNR is signed by two adult witnesses or a notary public.

How do I get a DNR in AZ?

2 ways to request a DNR form: Click here to download the DNR form now (print on orange paper) Call 602- 542-2123 or 800-352-8431 and leave a message.

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.

Can I print out a DNR form?

Download, Complete, and Sign. The DNR form should be printed and signed by both the doctor and patient in the presence of two witnesses.

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How do I declare myself 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.

What are the requirements for DNR?

The requirements for creating a DNR vary from state to state. In California, a DNR order must include the patients name and the date of the order, and must be signed by you (or your healthcare agent) and your physician. The DNR will be entered into your medical records.

Can you put yourself on DNR?

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.