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Prehospital Do Not Resuscitate Form & Information

This form was developed by the CA Emergency Medical Services Authority, in concert with the CA Medical Association and emergency medical services (EMS) providers, for purposes of instructing EMS personnel to forego resuscitation attempts in the event of a patient’s cardiopulmonary arrest. This form orders that no medical procedure be done to restart breathing or heart functioning if the heart stops beating or a person stops breathing. This form does not prevent a person from obtaining other emergency medical care and may be revoked at any time. This is a physician order that must be signed by your physician and is legally binding. The DNR form, guidelines and Frequently Asked Questions may be accessed via the link provided.

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