OUTSIDE THE HOSPITAL DO-NOT-RESUSCITATE (OHDNR) ORDER
Please complete the following form, and sign:
I AUTHORIZE EMERGENCY MEDICAL SERVICES PERSONNEL TO WITHHOLD OR WITHDRAW CARDIOPULMONARY
RESUSCITATION FROM THE PATIENT IN THE EVENT OF CARDIAC OR RESPIRATORY ARREST.
I affirm this order is the expressed wish of the patient/patient’s representative, medically
appropriate and documented in the patient’s permanent medical record.
THIS OHDNR ORDER SHALL REMAIN WITH THE PATIENT WHEN TRANSFERRED OUTSIDE THE HEALTH
CARE FACILITY.
Emergency Medical Services personnel shall not comply with an outside the hospital
do-not-resuscitate order when the patient or the patient’s representative expresses to such
personnel in any manner, before or after the onset of a cardiac or respiratory arrest, the desire
to be resuscitated or if the patient is or is believed to be pregnant.