Arkansas DNR Form: How to Get an Out-of-Hospital Do Not Resuscitate Order

When someone calls 911, paramedics are legally required to start CPR and aggressive life-saving interventions — chest compressions, defibrillation, intubation — unless they can immediately verify a valid Do Not Resuscitate order. A living will in a filing cabinet won't stop them. An unsigned form won't stop them. Only a properly executed Arkansas EMS-DNR order changes what happens in those first critical minutes.

Here's exactly how to get one.

What the Arkansas DNR Form Is (and Isn't)

The Arkansas Out-of-Hospital Do Not Resuscitate order (EMS-DNR) is a medical order — not a legal document like a living will. It specifically directs emergency medical services personnel to withhold CPR and life-support measures when they respond to a call at your home, nursing facility, or any out-of-hospital setting.

Key distinctions:

• A living will expresses your wishes but has no authority over paramedics
• A POLST covers broader treatment preferences across all settings (hospital and out-of-hospital)
• An EMS-DNR is narrowly focused: it tells first responders not to resuscitate

You may need both a POLST and an EMS-DNR depending on your situation — they serve different functions even though they overlap in philosophy.

Who Can Sign the Arkansas DNR Form

This is the most critical requirement: only a licensed physician (MD or DO) can sign a valid Arkansas EMS-DNR order. Arkansas law does not extend signature authority to Advanced Practice Registered Nurses (APRNs), Nurse Practitioners, or Physician Assistants.

This creates a real barrier in rural Arkansas counties where many clinics are staffed primarily by APRNs operating under Collaborative Practice Agreements. If your regular provider is an NP, you'll need to arrange for the supervising physician or another MD/DO to review and sign the form.

A DNR form signed by anyone other than a licensed physician is legally invalid. Emergency responders will treat it as if it doesn't exist and begin full resuscitation.

How to Request an EMS-DNR Order

1. Have the conversation with your physician. The DNR discussion typically happens during a serious illness, hospice transition, or when quality of life has declined to the point where resuscitation would not meaningfully help. Your doctor will assess whether an EMS-DNR aligns with your medical situation and wishes.

2. The physician signs the official form. The Arkansas Department of Health distributes the standardized Out-of-Hospital DNR Order form. Your physician must sign it, include their license number, and date it.

3. You (or your healthcare agent) also sign. The patient or their legally authorized representative must consent.

4. Obtain DNR identification. Arkansas allows the DNR order to be communicated through:

   • The signed paper form displayed prominently (refrigerator, bedside)
   • A standardized DNR identification bracelet or necklace engraved with your first and last name

Where to Keep the DNR Form

Visibility is everything. A DNR form locked in a desk drawer provides zero protection during a 911 call.

• Post it on the refrigerator — this is the standard location EMS is trained to check
• Keep a copy at the bedside if you're receiving home care
• Wear a DNR bracelet or necklace for 24/7 portable identification
• Provide a copy to your home health agency if you have regular caregivers
• Upload to your physician's electronic health record so it's documented in the hospital system too

What Happens Without a Valid DNR

If paramedics arrive and cannot immediately verify a DNR order, they will:

• Begin chest compressions
• Attempt defibrillation
• Intubate (insert a breathing tube)
• Administer cardiac medications
• Transport to the emergency department under full resuscitation protocols

These interventions can cause broken ribs, organ damage, and neurological injury — all of which the patient explicitly wanted to avoid. The legal standard is clear: without verified documentation, responders must intervene.

Revoking a DNR Order

You can revoke your EMS-DNR at any time by:

• Physically destroying the form
• Removing or destroying the DNR bracelet/necklace
• Verbally communicating revocation to treating medical personnel
• Having your healthcare agent communicate revocation (if you lack capacity)

Revocation takes effect immediately — no waiting period, no paperwork.

DNR vs. POLST: Do You Need Both?

A POLST is a broader document that covers CPR decisions plus additional orders about mechanical ventilation, antibiotics, artificial nutrition, and hospital transfer preferences. An EMS-DNR is specifically for the resuscitation question during an out-of-hospital emergency.

If you already have a POLST that indicates "Do Not Attempt Resuscitation," that POLST functions as your DNR order as well. However, some families choose to have both — the POLST as the comprehensive medical order set, and the DNR bracelet as immediate wearable verification.

The Rural Physician Access Problem

In rural Arkansas counties, finding a physician to sign your DNR form can take weeks. If your primary provider is an APRN or NP, they cannot sign it — regardless of how well they know your medical history and wishes.

Options for rural families:

• Ask your NP to facilitate a referral to the supervising physician for a POLST/DNR signing appointment
• Contact your local hospital's palliative care or social work department
• If you're on hospice, your hospice medical director (who must be a physician) can sign the form

Plan ahead. Don't leave this until a crisis forces a 911 call with no valid orders in place.

Coordinate Your DNR With Your Full Advance Directive

A DNR order works best as part of a complete advance care planning system — not as a standalone document. The Arkansas Advance Directive & Living Will Kit includes an EMS-DNR request template, a POLST coordination tracker, and a document distribution log that ensures the right forms are in the right places before an emergency happens. Complete the entire process once, correctly, instead of piecing together forms from separate sources.

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