No CPR Form

No CPR Form

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Cardiopulmonary resuscitation (CPR) is a treatment given when a person’s breathing stops or their heart stops beating (also known as cardiac or respiratory arrest). People who are approaching the natural end of their lives or suffering from a life-limiting or life-threatening illness, may not wish to receive CPR. A valid No CPR Form legally documents this deeply personal and deliberate decision. 

On this page:

Overview

If your heart or breathing stops and you have a valid No CPR Order, it means that your healthcare team or first responders will not try and restart them. Sometimes this is also referred to as “Do Not Resuscitate” or “DNR.” You can cancel a No CPR Order after it has been signed.

For a No CPR Form to be valid, it must be signed by:

  • A consenting adult (either you or your substitute decision maker)
  • Your physician or nurse practitioner

Medical Orders for Scope of Treatment (MOST) 

A MOST is another way to record your wishes for healthcare in the event that you are unable speak for yourself. It is based on conversations with your doctor or nurse practitioner about the levels of care and medical interventions you do or do not wish to receive in certain medical situations. A No CPR Order is only about CPR, whereas a MOST may include orders about CPR and other medical interventions.

Making the decision

Choosing to create a No CPR Order is a significant decision. It requires careful consideration of your personal circumstances, wishes and values. Discussing the decision with your loved ones and your healthcare team is encouraged. Your physician or nurse practitioner can help you understand the risks versus benefits of resuscitation.

Create a No CPR Order

When you have made the decision to create a No CPR Order, you will need to take the following steps:

  1. Download the No CPR Form (PDF, 591KB) or get a copy from your primary care provider’s office
  2. Read the front and back of the form thoroughly
  3. Fill out the patient portions of the form
  4. Ask your physician or nurse practitioner to complete the “physician/nurse practitioner” section of the form

No CPR Form (PDF, 591KB)

Once completed, a copy of the No CPR Form should remain with you, your next of kin providing care and your physician or nurse practitioner. If applicable, your community home care nursing services or residential care facility should also have a copy. People often put the form on their fridge at home so it can be easily seen.

You may also want to carry a copy of the form with you (for example, in your wallet or purse) or wear a No CPR bracelet or necklet. Emergency services personnel are trained to look for a MedicAlert® bracelet or necklet during an emergency. For more information about how to get a No CPR MedicAlert® bracelet or necklet and the cost involved, visit MedicAlert® Products and Services or call MedicAlert® toll-free at 1-800-668-1507.

Cancel a No CPR Order

You can change your mind and cancel the No CPR Order at any time, even after it has been signed by you and your physician or nurse practitioner. To do so, take the following steps as soon as possible: 

  • Speak to your physician or nurse practitioner
  • Tear up the signed No CPR Form
  • Stop wearing your MedicAlert® No CPR bracelet or necklet and inform MedicAlert® of the update (if applicable) 

If copies of the No CPR Order were shared with your next of kin, your community home care nursing service, or your long-term care facility, they should be informed of the canceled No CPR Order as soon as possible.

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