No Cardiopulmonary Resuscitation (No CPR) Medical Order

Capable patients may request that no cardiopulmonary resuscitation be started on their behalf. This should be done after discussions with their doctor or nurse practitioner. “No cardiopulmonary resuscitation” is defined as no cardiopulmonary resuscitation (no CPR) in the event of a respiratory and/or cardiac arrest.
This form is provided to you or your substitute decision maker to acknowledge that you have had a conversation with a physician or nurse practitioner about a No CPR Order, and understand that no CPR will be provided in circumstances where you can no longer make decisions for yourself. It instructs people such as first responders, paramedics and health care providers not to start CPR on your behalf whether you are at home, in the community or in a residential care facility.