Arizona DNR Form: The Orange Paper Rule and How to Execute a Prehospital Medical Care Directive

What Makes Arizona's DNR Different

Arizona calls its out-of-hospital Do Not Resuscitate order a "Prehospital Medical Care Directive" under A.R.S. § 36-3251. Unlike a standard hospital DNR that a physician writes in your medical chart, this document travels with you — at home, in an assisted living facility, in an ambulance — and tells first responders not to perform CPR or advanced life support if your heart stops.

The critical difference in Arizona: this directive is only valid if printed on orange paper. EMS personnel who encounter a DNR on white paper are legally required to begin resuscitation regardless of what the document says.

The Orange Paper Requirement

This is not an informal guideline. Arizona statute mandates that the Prehospital Medical Care Directive must appear on a bright orange background — either orange cardstock or white paper with an orange background printed in color. Wallet-sized versions must also maintain the orange background.

Skilled nursing facilities, hospice programs, and emergency departments across Arizona enforce this strictly. As one SNF nurse documented: "If you do not want to be resuscitated, we have to have the orange State DNR form. It literally doesn't matter what your advance directive says, or your living will. No official DNR, you're getting chest compressions."

Who Must Sign

A Prehospital DNR requires three signatures to be legally active:

1. The patient (or their legally authorized healthcare agent if the patient lacks capacity)
2. A witness — must be at least 18 and cannot be the designated healthcare agent
3. A licensed healthcare provider — a physician, nurse practitioner, or physician assistant licensed in Arizona

Without the provider co-signature, the document is a statement of personal preference, not an enforceable medical order. This distinguishes it from a Living Will, which does not require a clinical signature.

DNR vs. POLST vs. Living Will

These three documents operate at different levels:

Living Will — A legal directive expressing your general end-of-life treatment preferences. Activates only when you meet specific statutory conditions (terminal illness, vegetative state, irreversible coma). Does not require a provider signature.

Prehospital DNR — A specific medical order for one scenario: cardiac or respiratory arrest outside a hospital. Active immediately upon execution. Requires the orange paper and a provider signature.

POLST (Physician Orders for Life-Sustaining Treatment) — A comprehensive medical order set covering CPR, ventilation, antibiotics, nutrition, and hospitalization preferences. Active across all care settings. Requires a provider signature and is typically reserved for seriously ill or frail patients.

You may need all three, depending on your health status and goals of care.

How to Get the Orange Form

The Arizona Attorney General's Life Care Planning Packet includes a Prehospital DNR form with the correct orange background. If you download and print this PDF, you must use a color printer — a black-and-white printout on white paper does not satisfy the statutory requirement.

Alternatively, print the form content on pre-purchased orange cardstock from any office supply store. The content and layout must match the statutory format exactly.

Where to Keep It

Post the orange form in a visible location: on the refrigerator, next to the bed, or in a clearly labeled folder near the front door. If you live in an assisted living or memory care facility, provide a copy to the nursing station and ensure it is in your medical chart.

Also register it with the Arizona Healthcare Directives Registry (AzHDR) so hospital staff can confirm your status electronically if the physical form is not immediately available at the scene.

Getting It Right the First Time

The orange paper rule, physician signature requirement, and witness eligibility restrictions create multiple failure points. The Arizona Advance Directive & Living Will Kit includes the statutory DNR layout with printing instructions, a compliance checklist for the provider signature, and guidance on coordinating your DNR with your Living Will and Healthcare POA so all documents work together without contradictions.

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