Arizona Do Not Resuscitate (DNR) Order Form
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PREHOSPITAL MEDICAL CARE DIRECTIVE (DO NOT RESUSCITATE)
(IMPORTANT—THIS DOCUMENT MUST BE ON PAPER WITH ORANGE BACKGROUND)

GENERAL INFORMATION AND INSTRUCTIONS: A Prehospital Medical Care Directive is a document signed by you
and your doctor that informs emergency medical technicians (EMTs) or hospital emergency personnel not to
resuscitate you. Sometimes this is called a DNR – Do Not Resuscitate. If you have this form, EMTs and other
emergency personnel will not use equipment, drugs, or devices to restart your heart or breathing, but they will not
withhold medical interventions that are necessary to provide comfort care or to alleviate pain. IMPORTANT: Under
Arizona law a Prehospital Medical Care Directive or DNR must be on letter sized paper or wallet sized paper on an
orange background to be valid.
You can either attach a picture to this form, or complete the personal information. You must also complete the form
and sign it in front of a witness. Your health care provider and your w