Updated May 31, 2022
The Colorado do not resuscitate order form (DNR), also known as a “CPR Directive,” is a document supporting the request made by a Colorado resident stating that they do not wish to receive any resuscitation procedures by a medical professional if they are dying. This form is often requested by people who are weak from sickness or suffering from terminal illnesses. Once approved and signed by a patient’s physician, a DNR will prevent emergency responders and paramedics from resuscitating an individual who is wearing a DNR or CPR Directive indicator on their person.
Laws – § 15-186-(101 – 108)
Required to Sign – Patient and physician.
How to Write
Step 1 – Download in Adobe PDF.
Step 2 – The following patient information must be provided in the appropriate fields:
- Name
- Name of agent/authorized guardian (if applicable)
- Date of birth
- Gender
- Eye Color
- Hair color
- Race
- Name of hospice program (if applicable)
Step 3 – Under the ‘Physician’s Information’ section, enter the name, address, phone number, and license number of the patient’s physician.
Step 4 – Under ‘Directive Attestation,’ select all the check-boxes that apply. A patient signing on their own behalf will select the first checkbox. A proxy/agent authorized to act on behalf of the patient should select the second checkbox. The patient may choose to donate their skin, cornea and/or bones effective upon their death. To accomplish this, select any of the appropriate checkboxes under ‘Tissue Donation’.
Step 5 – At the bottom of the page, the patient (or authorized agent) and physician must include their signatures and the date.
