Free Arizona Prehospital Medical Care Directive Form | PDF & Word - ProDocs

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

Ensuring that your medical wishes are respected during an emergency is a fundamental right. In the state of Arizona, the Arizona Prehospital Medical Care Directive Form, commonly known as the “Orange Card,” serves as a critical legal instrument. This document allows individuals to formally state their preference regarding life-sustaining treatments, specifically cardiopulmonary resuscitation (CPR), before an emergency occurs.

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When seconds matter, first responders need clear, legally binding instructions. Our 2026 updated template is meticulously drafted to align with Arizona Revised Statutes § 36-3251. By utilizing this free, editable, and printable form, you can provide peace of mind for yourself and your family, ensuring that your healthcare autonomy is preserved even when you cannot speak for yourself.

Template Preview & Visual Guidance

A valid Arizona Prehospital Directive must follow a specific statutory format to be recognized by Emergency Medical Technicians (EMTs) and firefighters. Our preview showcases a professional layout including personal identification, the formal DNR (Do Not Resuscitate) declaration, and the essential signature sections for healthcare providers and witnesses.

Important Note: To meet state-wide EMS protocols, this document should ideally be printed on letter-sized orange paper to ensure immediate recognition in high-pressure situations.

What is the Arizona Prehospital Medical Care Directive?

The Arizona Prehospital Medical Care Directive is a specialized medical order intended for use outside of a hospital setting. While a standard DNR order might be placed in a patient’s hospital chart, this prehospital version is designed to be kept at home or carried by the individual. It specifically instructs prehospital providers—such as paramedics and first responders—not to perform resuscitative measures if the person's heart stops or they stop breathing.

According to the Arizona Department of Health Services, this directive is legally distinct from a Living Will. While a Living Will provides broad instructions for hospital care, the Prehospital Directive is a specific command to field medics to allow a natural death.

Key Features of Our Professional Template

Our template is engineered to meet the stringent requirements of Arizona law, featuring:

Strict Statutory Language: Uses the exact phrasing required by AZ Revised Statutes.
Identification Section: Dedicated space for a recent photograph or a physical description to prevent misidentification.
Provider Certification: A clear section for a licensed physician, physician assistant, or nurse practitioner to sign, as required by law.
Witness/Notary Flexibility: Includes proper blocks for either a qualified witness or a notary public.
Standardized Layout: Matches the "Orange Card" visual expectations of Arizona EMS personnel.

How to Execute and Use This Template

To make your Arizona Prehospital Medical Care Directive Form legally enforceable, you must follow these specific steps mandated by the state:

1. Physician Consultation

Arizona law requires that a licensed healthcare provider signs this form. They must certify that you have the capacity to make this decision and that they have explained the consequences of refusing CPR. This step is non-negotiable for the form's validity.

2. Verification of Identity

The form must include a way for responders to verify it belongs to you. You must either attach a photograph (taken within the last six months) or provide a detailed physical description including height, weight, eye color, and hair color.

3. Legal Witnessing

You must sign the form in the presence of at least one witness who is not related to you by blood or marriage, nor entitled to any part of your estate. Alternatively, you may have the document signed before an Arizona Notary Public.

4. Strategic Placement

Once signed and printed on orange paper, place the original in a conspicuous location. In Arizona, the refrigerator door is the standard location where EMTs are trained to look. You may also keep a wallet-sized version with you when traveling.

Why This Template is Essential for Estate Planning

Attempting to draft a medical directive without the proper legal framework can lead to devastating consequences. If a document is missing a physician’s signature or doesn't follow the state-approved language, first responders are legally obligated to perform CPR, regardless of your personal wishes. Using our verified template ensures that your right to a natural death is protected by law.

Frequently Asked Questions (FAQ)

Is the Arizona Prehospital Directive the same as a Living Will?

No. A Living Will provides general instructions for hospital-based end-of-life care. The Prehospital Directive is a specific order for EMTs and paramedics to avoid CPR outside of a hospital.

Does this form need to be printed on orange paper?

While the law focuses on the content, Arizona EMS protocols specifically look for the "Orange Card." Printing on orange paper is highly recommended for immediate visibility.

Can I cancel or revoke this directive?

Yes. You can revoke it at any time by destroying the document, or by verbally telling medical personnel that you have changed your mind.

Does this form require a lawyer?

No, a lawyer is not required. However, you must have it signed by a licensed healthcare provider (MD, DO, PA, or NP).

Can I use this form in other states?

While some states may honor out-of-state directives, this specific form is tailored to Arizona's unique statutory requirements.

What happens if I don't have this form?

Without a valid prehospital directive or "Orange Card," Arizona emergency responders are required by law to perform all life-saving measures, including CPR and intubation.