For more information on and to receive a copy of the Prehospital Do Not Resuscitate (DNR) Form, please contact the California Medical Association at 1-415-882-5175. The Purpose of this form is to instruct the Emergency Medical Services (EMS) personnel to forgo resuscitation attempts in the event a patient's cardiopulmonary arrest. Resuscitative measures to be withheld include chest compressions, assisted ventilation, endotracheal intubation, defibrillation, and cardiotonic drugs. The form does not affect the provision of other emergency medical care, including palliative treatment for pain, dyspnea, major hemorrhage, or other medical conditions.
The Prehospital DNR form must be signed by the patient or by an appropriate surrogate decision-maker if the patient is unable to make or communicate informed health care decision. The patient's physician must also sign the form, affirming that the patient/ surrogate has given informed consent.
