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Alaska Do Not Resuscitate (DNR) Order Form – Sample Only

The Alaska Do Not Resuscitate (DNR) order form is primarily used by individuals who are in the late stages of a terminal disease and do not want to be resuscitated if they experience heart or breathing failure. The form may only be obtained from a licensed physician practicing in the State of Alaska.
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Updated June 14, 2024

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  • Laws – AS 13.52.150
  • Required to Sign – Patient and physician.
  • If you’re a licensed physician you can obtain the forms by calling your respective region’s Comfort One Office:
    • Southern Region EMS Council, Anchorage – (907) 562-6449
    • Interior Region EMS Council, Fairbanks – (907) 456-3978
    • Southeast Region EMS Council, Sitka – (907) 747-8005
  • Comfort One Program – This is the official office that handles do-not-resuscitate forms in Alaska. If you are a patient that has been approved, you can also get a wallet card and a bracelet in case you cannot speak for yourself while receiving care.

Sample