Arizona DNR: Do Not Resuscitate Form, Signatures, and Revocation

An Arizona Do Not Resuscitate order is created by completing the state’s prehospital medical care directive — the “orange form” — under Arizona Revised Statutes 36-3251. To meet Arizona DNR requirements, the form must be printed on orange paper or with an orange background, carry the patient’s identifying information, and be signed by the patient (or an authorized representative), a licensed healthcare provider who explained the consequences, and a witness. Notarization is not required, and the directive stays in effect until it’s revoked.

What the Orange Form Must Contain

The directive must be printed on orange paper or have an orange background so first responders can identify it on sight.¹ It can be letter-sized or wallet-sized. You do not have to use the form published by the Arizona Department of Health Services, but any version you use has to meet the same statutory requirements.

Side one carries the patient’s statement refusing resuscitation measures — chest compressions, advanced airway management, artificial ventilation, defibrillation, and cardiac drugs. Below the patient’s signature line, the form asks for either a recent photograph or identifying information: date of birth, sex, eye color, hair color, and race. There is also space for the hospice program, if any, and the patient’s physician’s name and phone number.¹

Side two holds two additional signature lines: one for the licensed healthcare provider who explained the form, and one for a witness. Keep the completed form somewhere responders will find it quickly. The refrigerator door is the conventional spot. A wallet-sized copy or a medical alert bracelet referencing the directive can back that up.

Who Can Sign for the Patient

The patient is always the primary decision-maker, but Arizona law recognizes two others who can step in when the patient can’t.

The Patient

Any competent adult can complete and sign the directive. Competent here means the person understands that emergency responders will not attempt CPR if cardiac or respiratory arrest occurs, and that death is the likely result.¹ A licensed healthcare provider must explain those consequences before the patient signs. If the patient later loses decision-making capacity, the previously signed directive stays in effect until someone with legal authority revokes it.

A Healthcare Agent

Under ARS 36-3221, any adult can name another adult as a healthcare agent through a written health care power of attorney.² Once a physician determines the patient is incapacitated, that agent can make medical decisions, including signing a DNR directive. The agent must act on the patient’s known wishes; if those aren’t clear, the agent must act in the patient’s best interest. The Arizona Attorney General’s office publishes a health care power of attorney form that includes a prompt asking whether the person already has a prehospital medical care directive.³

A Court-Appointed Guardian

When a court has declared someone legally incapacitated and appointed a guardian, ARS 14-5312 lets the guardian consent to medical care and act under Title 36, Chapter 32, which covers healthcare directives and DNR orders.⁴ The guardian’s decision must align with the ward’s best interests and any previously expressed wishes, and family members who disagree can petition the court for review.

The Three Required Signatures

A valid prehospital medical care directive needs three signatures.

The patient or an authorized representative signs or makes a mark on side one. If the patient is incapacitated, the healthcare agent or guardian signs in that spot.¹
A licensed healthcare provider signs side two, confirming they explained the form and that the signer understands refusing care could result in death. According to the Arizona Department of Health Services, the providers who qualify include licensed practical nurses, registered nurses, nurse practitioners, medical doctors, doctors of osteopathy, and physician assistants.⁵
A witness signs side two, attesting that the patient appeared to be of sound mind and free from duress at the time of signing.¹

Without the provider’s signature, first responders may question the form and default to performing CPR. The broad list of eligible providers is worth noting: a doctor’s appointment isn’t strictly required. A registered nurse or licensed practical nurse who explains the consequences and signs the form satisfies the statute.

Where the Directive Applies

The name “prehospital” understates the form’s reach. ARS 36-3251 directs three categories of personnel to honor it: emergency medical system personnel, hospital emergency department staff, and direct care staff at certain facilities.¹

Direct care staff — people employed to provide services in settings like group homes and assisted living facilities — can follow the directive only if the patient’s physician has ordered a hospice plan of care.¹ Without that hospice order, direct care staff in these facilities should call EMS rather than independently withholding resuscitation.

If anyone involved has doubts about whether a directive is genuine or whether the situation calls for honoring it, the law tells them to proceed with resuscitation until things are clarified. EMS personnel and direct care staff are not required to interpret directives that don’t meet the statutory requirements.¹ When a patient with a directive is admitted to a hospital or transferred between facilities, the form should travel with them and become part of the medical record.

What the Orange Form Does Not Cover

The prehospital medical care directive does one thing: it tells responders not to perform CPR during cardiac or respiratory arrest. It does not address ventilators, feeding tubes, pain management, or other treatment decisions. For those, Arizona recognizes other tools.

A living will is broader. Under ARS 36-3261, any adult can prepare a written statement controlling healthcare treatment decisions made on their behalf.⁶ It can cover artificial nutrition, ventilator support, and treatment intensity for terminal illness or permanent unconsciousness, and it can be used alongside or instead of a health care power of attorney.

Arizona also participates in the national POLST (Physician Orders for Life-Sustaining Treatment) program. A POLST form lets seriously ill or frail patients specify preferences across a range of interventions as actual medical orders that responders follow immediately, rather than as expressed wishes. Patients with terminal illness or advanced frailty may want to discuss a POLST with their physician alongside or instead of the orange form.

Revoking or Replacing the Directive

A prehospital medical care directive stays in effect until it’s revoked or replaced by a new document.¹ A competent patient can revoke at any time. The cleanest approach is to destroy the physical form and any copies, then tell your healthcare provider so your medical records reflect the change. Verbal revocation is also possible; communicate it clearly to a medical professional, ideally with someone else present so there’s no later dispute.

A healthcare agent who authorized a DNR while the patient was incapacitated can revoke it if circumstances change. A court-appointed guardian can do the same, consistent with the ward’s best interests. If a patient regains decision-making capacity, they can revoke the directive themselves regardless of who signed it originally.

After revocation, make sure the change reaches everyone who might encounter the old form. Notify your doctor’s office, any facility where you receive care, and any family members who might present the form in an emergency. Retrieve or destroy wallet cards and take the form off the refrigerator. A stale orange form in a visible location during a crisis is the kind of thing that leads to your wishes being ignored.

Provider Immunity for Following a DNR

Healthcare providers who follow a DNR in good faith are shielded from criminal liability, civil lawsuits, and professional discipline under ARS 36-3205.⁷ The same protection extends to providers who rely on an apparently genuine prehospital directive, including a photocopy on orange paper, as long as they make a good faith effort to identify the patient.¹ The law presumes good faith, and only clear and convincing evidence of improper motive rebuts that presumption.

A provider who objects to honoring a DNR on grounds of conscience must promptly tell the patient or their representative and transfer care to a willing provider. Silence is not an option; the statute requires prompt disclosure and transfer.⁷

1
Arizona Legislature. Arizona Code 36-3251 – Prehospital Medical Care Directives; Form; Effect; Immunity; Definitions
2
Arizona Legislature. Arizona Revised Statutes 36-3221 – Health Care Power of Attorney; Scope; Requirements; Limitations; Fiduciaries
3
Office of the Arizona Attorney General. Life Care Planning: Health Care Power of Attorney
4
Arizona Legislature. Arizona Code 14-5312 – General Powers and Duties of Guardian
5
Arizona Department of Health Services. Bureau of Emergency Medical Services and Trauma System – DNR Requirements
6
Arizona Legislature. Arizona Code 36-3261 – Living Will; Verification; Liability
7
Arizona Legislature. Arizona Code 36-3205 – Health Care Providers; Immunity from Liability; Conditions