Bureau of Emergency Medical Services & Trauma System

Do Not Resuscitate Form

The Prehospital Medical Care Directive form (commonly known as the Do Not Resuscitate or DNR form) is authorized by A.R.S. § 36-3251. The DNR form allows an individual to indicate that he or she does not want to be resuscitated if he or she suffers cardiac or respiratory arrest. The form allows an individual to declare that the following resuscitative measures are not to be used: cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration of advanced cardiac life support drugs and related emergency medical procedures. The DNR form does not authorize the withholding of other medical interventions, such as intravenous fluids, oxygen, or other therapies deemed necessary to provide comfort care or to alleviate pain.

Emergency medical system and hospital emergency department personnel who make a good faith effort to identify the patient and who rely on an apparently genuine DNR form or photocopy of a DNR form on orange paper are immune from liability to the same extent and under the same conditions as prescribed in A.R.S. § 36-3205. If a person has any doubt as to the validity of a DNR form or the medical situation, that person shall proceed with resuscitative efforts as otherwise required by law. Emergency medical system personnel are not required to accept or interpret medical care directives that do not meet the requirements of A.R.S. § 36-3251.

Specifications regarding the DNR form:

  • The DNR form must be printed on an orange background and may be in either letter or wallet size.
  • The DNR form must include the wording mandated by A.R.S. § 36-3251.
  • A person who has a valid DNR form may wear an identifying bracelet on either the wrist or ankle. The bracelet must:
    • Be substantially similar to identification bracelets worn in hospitals;
    • Be on an orange background; and
    • State in bold type:
      • Do Not Resuscitate,
      • Patient's name, and
      • Patient's physician.

Free copies of the DNR form may be requested by contacting us, or you can print your own copies using the files below. Please remember that the law requires the form to be printed on orange paper!

Note: Forms provided in PDF format.

Information and forms are also available on the Arizona Attorney General website which may be of additional assistance.