Colorado Do Not Resuscitate Order (DNR) Form

Colorado DNR form is a legal document made by a Colorado citizen, in which they state the unwillingness to receive any medical resuscitation treatments when dying.

This form is usually completed by people who are already aware of their current health situation, which is typically a terminal illness. Under CRS 15 -18.6- 102 law, for this form to come into action, it must be read and signed not only by the person who is willing to file it but also by their physician.

When approved, this DNR form takes away the right of any doctor to make resuscitation procedures on the person.

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Download your fillable Colorado DNR form in PDF format.

How to Fill out the Colorado DNR Form

Now let us ease the process of filling the DNR form out by describing the exact steps that you should follow when you download or print the form.

1. First, write down the complete personal information of the patient in this Colorado DNR Form.
This would include your:

  • Full name
    step 1 to filling out the colorado dnr form - full name
  • Name of the agent or guardian, if that is applicable to your case

step 1 to filling out the colorado dnr form - name of the agent or guardian, if that is applicable to your case

  • Date of birth, gender, and hair color
    step 1 to filling out the colorado dnr form - date of birth, gender, and hair color
  • Race/ethnicity
    step 1 to filling out the colorado dnr form - race ethnicity
  • Name of a hospice program, if again, is applicable to you.
    step 1 to filling out the colorado dnr form - name of a hospice program, if again, is applicable to you

2. Second, you would need to fill out some information regarding your physician. This should be the one who will read and sign it.
Here is what is required:

  • The physician’s name
    step 2 to filling out the colorado dnr form - the physicians name
  • The physician’s current address
    step 2 to filling out the colorado dnr form - the physicians current address
  • Their telephone and license number
    step 2 to filling out the colorado dnr form - their telephone and license number

3. The third piece of information that needs to be written down is connected with a directive attestation.
Here you would need to take the following steps:

  • Write down the date when this document is filled and signed
    step 3 to filling out the colorado dnr form - write down the date when this document is filled and signed
  • After that, check one of the two boxes presented in the document. This should be done either by the patient who is 18 years old or more (if that, check the first box) or their agent/guardian (in this case, check the second box)
    step 3 to filling out the colorado dnr form - check one of the two boxes presented in the document

4. The fourth step you would need to do is place signatures, both by the patient/guardian and their physician.
Being the patient/representative, you would also need to check the box that states your position as the patient or their representative.

However, before signing the document, please make sure that all information is filled out correctly.

Otherwise, the document would not work, and you, as the patient who does not want to receive any resuscitation procedures, would not want that.
step 4 to filling out the colorado dnr form

5. The fifth and the last step is not obligatory: here, you would need to check the boxes of those organs or tissues you would like to grant as an anatomical gift after your death. The signature of the donor is also required here.

step 5 to filling out the colorado dnr form

Published: Oct 18, 2021