Prehospital Medical Directive (Do Not Resuscitate)

Arizona law A.R.S. §36-3251 authorizes the Prehospital Medical Care Directive, which is commonly referred to as the Do Not Resuscitate or “DNR” form. As the name indicates, the DNR instructs certain medical personnel to forgo resuscitation if the patient stops breathing or if the patient’s heart stops beating.

The DNR must meet strict requirements to be valid. First of all, it must be printed on an orange background in either letter or wallet size. Secondly, the wording of the DNR must comply with A.R.S. §36-3251. The DNR must also be signed and dated, and must include either a recent photograph or a detailed description of the signer. The language on the backside of the DNR must also comply with A.R.S. §36-3251, and must be signed by a licensed health care provider and a witness.

A person with a DNR may wear an identifying bracelet on either the wrist or the ankle. As with the standard forms, bracelets must comply with the statute to be valid, hi short, the bracelet must be printed on an orange background, and state in bold type “Do Not Resuscitate,” the patient’s name, and the patient’s physician information.

It is important to keep in mind that DNRs are only effective outside a hospital by emergency medical system personnel or in a hospital emergency room. Emergency medical system personnel includes emergency medical technicians who are certified by the department of health services and medical personnel licensed by the state of Arizona but operating outside of an acute care hospital under an agency recognized by the department of health services. In other words, outside of an emergency room setting, generally only paramedics are permitted by law to recognize a DNR. Moreover, except for the emergency room, DNRs are not effective in any unit of the hospital.

If an individual has executed a DNR, emergency personnel will not use the following methods of resuscitation if he or she stops breathing or has heart failure:

  • Cardiopulmonary resuscitation (CPR)
  • Cardiac compressions
  • Endotracheal intubation and other advanced airway management
  • Artificial ventilation
  • Defibrillation
  • Administration of advanced cardiac life support drugs
  • Related emergency medical procedures

Other forms of medical interventions may still be used, such as:

  • Intravenous fluids
  • Oxygen
  • Other therapies that provide comfort or pain relief

Emergency medical system and hospital emergency department personnel who rely on an apparently valid DNR are immune from legal action. If a person has any doubt as to the validity of a DNR form or the medical situation, then the person will proceed with normal resuscitation as required by law.

DNRs are not for everybody. Those who are healthy and strong will likely opt to express their wishes about how they should be cared for if they become seriously ill without executing a DNR. DNRs are most appropriate for:

  • Individuals who might be injured by CPR because they are very sick
  • Terminally ill individuals who do not want to be saved in the event of an emergency
  • Individuals who are otherwise extremely weak.

Before completing a DNR individuals should consult with a physician, who will also need to sign the form.

For language that can be copied verbatim on orange background and used for a DNR form, visit the JacksonWhite Elder Law Web site at http://www.arizonaseniorlaw.com and click on Resources.

Dispelling ALTCS Myths

Senior News now has a column dedicated to dispelling common myths about ALTCS and other Arizona benefit programs. Look here every upcoming edition for interesting facts that will allow you to learn more about the ALTCS program whether you are a seasoned veteran or a rookie to Arizona’s health care systems.

Myth: If my income is over $1,911, I can not get on ALTCS.
Truth: It is true that ALTCS has income limits. Currently, this amount is set at $1,911 but this number increases annually every January 1st. HOWEVER, if one’s income is above this limit, an applicant can establish a Miller/Income-Only Trust and still be qualified for the same ALTCS program and benefits

This Summer, “Surf” the Web!
New Web-Based Resources Help Health Care Professionals and Families with Long-Term Health Care Questions and Concerns

The JacksonWhite Elder Law Team is proud to announce the launch of our new Web site! The new site is full of information about ALTCS and VA benefits, advanced directives and other useful information for people working in and around Arizona’s health care community. The new site even has a resource page dedicated to health care professionals. Visit and bookmark www.arizonaseniorlaw.com today! Since we are trying to make this the best possible site for you, we welcome your comments and suggestions. Please send all comments and Web site suggestions to jallen@jacksonwhitelaw.com.

In conjunction with the new Web site, the JacksonWhite Elder Law Team also started a blog with bi-weekly postings highlighting current events, Medicare/Medicaid updates and trends in Arizona’s health care community. The blog even has a feature allowing you to subscribe to an RSS feed so the new articles can be viewed in the “Favorites” section of your browser. Visit www.arizonaseniorlaw.com/blog for more information.

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