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New Mexico EMS DNR Order Form (NMDOH EMS Bureau)

New Mexico's standardized prehospital DNR order lets EMS providers withhold chest compressions, intubation, defibrillation, cardiac medications and artificial respiration when a covered person is in cardiac or respiratory arrest. The EMS Bureau developed it under Section 24-10B-4I NMSA 1978, and NMAC 7.27.6 describes the program. It applies at home, in long-term care, during transport and elsewhere outside acute care hospitals.

Who completes it

A primary care practitioner (physician, physician assistant, certified nurse practitioner or certified nurse midwife) explains the order, alternatives and revocation, then signs to affirm an informed decision. The adult patient, or an authorized health care decision maker for a minor or a patient who cannot consent, also signs.

Submitting and payment

How to submit it
Print three copies: the patient keeps one in a white envelope with the EMS DNR Order Inside cover sheet stapled on, one goes in the permanent medical record, and one is sent with an enrollment form if a bracelet is wanted.
Who pays
The Medic Alert Foundation supplies the optional EMS bracelet or neck medallion for a fee, which can be waived for patients who cannot afford it when certified by the primary care practitioner.

Good to know

  • Other emergency care continues under the order, including oxygen, suctioning, bleeding control, pain medication and comfort care.
  • The order or approved bracelet must be readily available; resuscitation may begin until it is presented, so keep the envelope in an obvious place.
  • For EMS treatment only, the order takes precedence over a durable health care power of attorney.
  • The patient can revoke it orally, by a later order or by destroying it; the practitioner should be told, and all copies, medallions and wallet cards destroyed.

Get the official form

Download the current version from the source each time; forms change without notice.

EMS DNR Order

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can sign a New Mexico EMS DNR order?

The order is executed with a primary care practitioner, defined on the form as a physician, physician assistant, certified nurse practitioner or certified nurse midwife. Both the practitioner and the adult patient sign, or the authorized health care decision maker signs if the patient is a minor or cannot give informed consent.

How does a New Mexico patient get an EMS DNR bracelet?

Send one signed copy of the order, with a Medic Alert enrollment form and the fee, to the Medic Alert Foundation, the EMS Bureau's approved supplier. The bracelet or medallion is inscribed Do Not Resuscitate EMS. It is optional, but the form strongly encourages it because it helps EMS identify the patient quickly.