» » Colorado Do Not Resuscitate (DNR) Order Form

Colorado Do Not Resuscitate (DNR) Order Form

Create a high quality document online now!

The Colorado do not resuscitate order form (DNR), also known as a ‘CPR Directive’, is a document supporting the request made by a Colorado citizen 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.


ABOUT SSL CERTIFICATES