Oklahoma Do Not Resuscitate (DNR) Order FormOklahoma Do Not Resuscitate (DNR) Order Form
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OKLAHOMA DO­NOT­RESUSCITATE (DNR) CONSENT FORM
I,
, request limited health care as
described in this document. If my heart stops beating or if I stop breathing, no
medical procedure to restore breathing or heart function will be instituted by any
health care provider including, but not limited to, emergency medical services
(EMS) personnel.

I understand that this decision will not prevent me from receiving other health
care such as the Heimlich maneuver or oxygen and other comfort care measures.
I understand that I may revoke this consent at any time in one of the
following ways:

1. If I am under the care of a health care agency, by making an oral, written, or
other act of communication to a physician or other health care provider of a
health care agency;

2. If I am not under the care of a health care agency, by destroying my do­not­
resuscitate form, removing all do­not­resuscitate identification from my person,
and notifying my attending physician of the revocation;

3. If I am in