Alabama Do Not Resuscitate (DNR) Order FormAlabama Do Not Resuscitate (DNR) Order Form
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Alabama Portable Physician Do Not Attempt Resuscitation Order
No CPR/ Allow Natural Death
______________________________________________________________________
Patient/Resident Full Name (PRINT) and Date of Birth:
Instructions. This order is valid only if Section I, II, III, OR IV is completed AND a
physician has completed Section V.
Section I. Patient/Resident Consent.
I, the undersigned patient/resident, direct that resuscitative measures be withheld
from me in the event of cardiopulmonary cessation. I have discussed this decision with
my physician, and I understand the consequences of this decision.
__________________________________
Signature of Patient/Resident

_______________________
Date

Section II. Incompetent Patient/Resident with DNAR instructions in Advance Directive.
The patient/resident is not competent or is no longer able to understand,
appreciate, and direct his/her medical treatment and has no hope of regaining that
ability. A duly executed Advance Directive for Hea