Arizona Prehospital Medical Care Directive Form: Free PDF & Word Templat

Template Preview & Visual Overview

Before proceeding with the download, it is essential to understand the structure of the document. Our Arizona Prehospital Directive template follows the standardized format mandated by the Arizona Department of Health Services. You will notice dedicated sections for identifying information, a clear statement of DNR (Do Not Resuscitate) intent, and the mandatory verification area for a licensed healthcare provider and witnesses.

Pro Tip: To ensure this document is legally recognized by field medics, Arizona guidelines strongly recommend printing the final signed version on bright orange paper. This visual cue is what emergency personnel look for during a crisis.

What is the Arizona Prehospital Medical Care Directive?

The Arizona Prehospital Medical Care Directive is a specific legal document that tells healthcare providers and emergency responders not to attempt CPR if your breathing or heartbeat stops. This document is unique because it applies specifically to settings outside of a hospital, such as your home, a nursing facility, or in an ambulance.

According to the Arizona Department of Health Services (ADHS), this form is intended for individuals with terminal conditions or those who have reached an age where they prefer natural death over aggressive medical intervention. It differs from a "Living Will" in that it is an immediate order for field personnel, whereas a Living Will is usually interpreted by doctors within a hospital setting.

Who Needs This Form?

• Individuals diagnosed with a terminal illness.
• Seniors who wish to avoid the physical trauma associated with resuscitation.
• Patients with chronic conditions who have specific quality-of-life preferences.
• Anyone who has already established a Healthcare Power of Attorney and wants to reinforce their DNR status.

Key Features of Our Arizona Directive Template

Our document is engineered to meet the highest legal and professional standards used in the United States. Key features include:

• Statutory Compliance: Drafted according to the exact language of ARS § 36-3251.
• Identification Precision: Includes required space for a photograph or detailed physical description to ensure first responders identify the correct person.
• Healthcare Provider Section: A designated area for your doctor’s mandatory signature and medical license number.
• Witness/Notary Integration: Clear instructions and fields for the necessary legal verification.
• Universal Accessibility: Optimized for both digital editing and manual handwriting.

How to Correctly Use and Validate Your Template

Simply downloading the form is the first step. To make it a "living" legal document in the state of Arizona, follow these precise steps:

Step 1: Consultation with a Licensed Provider

You must discuss your decision with a licensed physician, physician assistant, or nurse practitioner. Arizona law requires a medical professional to sign the document, certifying that you have the capacity to make this decision and that they have explained the consequences of forgoing CPR.

Step 2: Identification and Completion

Fill out the personal details accurately. You must either attach a recent photograph of yourself to the form or provide a detailed physical description (height, weight, eye color, hair color, and any distinguishing marks). This prevents accidental non-resuscitation of the wrong individual.

Step 3: Execution with Witnesses or a Notary

Sign the form in the presence of at least one witness who is not a family member or an heir to your estate. Alternatively, you may have the document notarized by an Arizona Notary Public to ensure maximum legal weight.

Step 4: The "Orange Card" Strategy

While the law technically accepts the form on any paper, the medical community in Arizona is trained to look for the "Orange Card." Print the form on 8.5" x 11" orange paper. Keep the original in a highly visible place—the most common location is the refrigerator door or the back of the bedroom door.

Why Use a Standardized Template?

In the high-stress environment of an emergency, paramedics do not have time to read through complex, custom-written letters. They are trained to recognize the layout of the official Arizona Prehospital Medical Care Directive. Using our standardized template ensures:

1. Zero Ambiguity: Medics instantly understand your refusal of treatment.
2. Immediate Recognition: The layout matches state-wide EMS training modules.
3. Liability Protection: Protects medical professionals from legal repercussions when they follow your documented wishes.

Frequently Asked Questions

Related Professional Documents

• Arizona Durable Health Care Power of Attorney
• Arizona Living Will and End-of-Life Instructions
• Arizona Mental Health Care Power of Attorney