Colorado DNR Form: How to Set Up a Pre-Hospital CPR Directive

The most dangerous misconception in Colorado advance care planning: believing a living will stops EMTs from performing CPR. It does not. If someone calls 911 and your heart has stopped, Colorado paramedics are legally required to perform full cardiopulmonary resuscitation unless they see an original, physician-signed CPR Directive or MOST form at the scene.

That distinction — between a legal declaration you sign at home and a medical order your doctor signs — is the gap where families experience the most traumatic outcomes.

Hospital DNR vs. Outpatient CPR Directive

A DNR order issued during a hospital stay expires when you are discharged. It applies only within that facility. Once you leave — whether to home, hospice, or an assisted living residence — that hospital DNR has no legal authority over emergency responders.

Colorado's outpatient CPR Directive is the document that follows you outside the hospital. It is a portable medical order, governed by state EMS protocols, that tells paramedics and EMTs: do not attempt resuscitation. The form must be signed by both the patient (or their MDPOA agent) and a licensed physician, APRN, or physician assistant.

What the CPR Directive Covers

The CPR Directive addresses a specific, narrow clinical scenario: cardiac or respiratory arrest outside of a hospital. It instructs first responders to withhold chest compressions and defibrillation, not insert a breathing tube (intubation), and not administer cardiac drugs. Instead, responders provide comfort measures — pain management, oxygen for breathing difficulty, and positioning.

If you want broader coverage — including decisions about hospital transfers, IV antibiotics, mechanical ventilation, and artificial nutrition — you need the MOST form in addition to or instead of a standalone CPR Directive.

How to Get the Form Completed

You cannot download, fill out, and sign a CPR Directive by yourself. The process requires a clinical conversation:

1. Schedule a visit with your primary care physician, APRN, or PA. Explain that you want to discuss a pre-hospital CPR directive.
2. Discuss your clinical situation. The provider will evaluate whether a DNR is clinically appropriate based on your diagnosis, prognosis, and treatment goals.
3. Complete the state-standard form together. The provider fills in the medical details and signs the form, recording their medical license number.
4. Sign the form yourself (or have your MDPOA agent sign if you lack capacity).
5. Place the original in a visible location. Colorado best practices: tape it to the inside of the front door, place it on the refrigerator, or keep it at the bedside for homebound patients. Photocopies, scans, and faxes are legally acceptable.

Some patients also wear a state-standardized DNR bracelet or pendant, which alerts EMTs before they begin intervention.

The MOST Form Alternative

For people with serious chronic illness or advanced frailty, the MOST form (Medical Orders for Scope of Treatment) is the more comprehensive option. It includes a CPR section plus additional medical orders covering ventilation, antibiotics, hospital transfer, and artificial nutrition. Under C.R.S. § 15-18.7-101, the MOST form is portable — it follows you between hospitals, nursing homes, assisted living, and home care settings.

Completing a MOST form is voluntary. No care facility in Colorado can require it as a condition of admission under C.R.S. § 15-18.7-108.

How the CPR Directive Relates to Your Other Documents

Your CPR Directive works alongside — not instead of — your living will and MDPOA. The living will states your treatment preferences for terminal illness and permanent unconsciousness. The MDPOA names your decision-maker. The CPR Directive gives emergency responders their marching orders in the first critical minutes before a hospital team gets involved.

Without the CPR Directive, your living will sits in a drawer while paramedics perform exactly the interventions you documented a preference against.

Prepare for the CPR Directive Conversation

The Colorado Advance Directive & Living Will Kit includes a treatment preferences worksheet designed to prepare you for the clinical conversation with your doctor, sample language for discussing CPR directives with providers, and a storage and distribution checklist so the signed form is visible during an emergency.

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