Purpose:
Allows you to state that you do not want to be resuscitated if you stop breathing or your heart stops beating, and declare that certain resuscitative measures will not be used on you.
Notes:
- Document becomes effective immediately and remains in effect until the patient is pronounced dead by an authorized medical or legal authority or the document is revoked.
- The resuscitative measures specifically listed in the OOH DNR legislation are CPR, advanced airway management, defibrillation, artificial ventilations, and transcutaneous cardiac pacing.
- Without this document, calling 911 will always result in resuscitative attempts.
- Should transport (ambulance) occur, this document or a copy must accompany the patient.
- Requires 2 witnesses and physician’s statement.
Download the Template:
Out of Hospital Do Not Resuscitate Order