Arizona's statutory out-of-hospital DNR form lets a person refuse resuscitation, including chest compressions, intubation, artificial ventilation, defibrillation and advanced cardiac life support drugs. The patient signs side one and attaches a photo or lists identifying details, and on side two a licensed health care provider confirms explaining the form and its consequences. The form must be printed on orange paper.
The patient signs or marks side one and adds a photo or identifying details, any hospice program and the physician's name. A licensed health care provider signs side two, and a witness confirms the patient appeared to be of sound mind and free from duress.
Download the current version from the source each time; forms change without notice.
Prehospital Medical Care Directive
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.
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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Yes. A.R.S. 36-3251 describes the prehospital directive as having an orange background, so the letter-size or wallet-size version should be printed on orange paper. ADHS offers the form in English and Spanish.
Three people sign. The patient signs or marks side one, a licensed health care provider signs side two after explaining the form and its consequences, and a witness signs that they were present and the patient appeared of sound mind and free from duress. ADHS's letter explains which providers may sign.