ALABAMA DO NOT RESUSCITATE (DNR) / DO NOT ATTEMPT RESUSCITATION (DNAR) DIRECTIVE
(Comprehensive Template – Court-Ready)
[// GUIDANCE: This template is drafted to comply with Ala. Code §§ 22-8A-1 et seq. (Alabama Natural Death Act) and the Alabama Department of Public Health (“ADPH”) EMS protocol for DNAR orders. Customize all bracketed items and remove Guidance comments before execution.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions (Medical Order)
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block (with Witness & Physician Statements)
1. DOCUMENT HEADER
ALABAMA DO NOT RESUSCITATE / DNAR DIRECTIVE
Effective Date: [EFFECTIVE DATE]
This Do Not Resuscitate / Do Not Attempt Resuscitation Directive (the “Directive”) is executed pursuant to and governed by the Alabama Natural Death Act, Ala. Code §§ 22-8A-1 et seq., and any successor statutes or regulations (collectively, the “State Health-Care Law”).
Parties:
• Patient: [PATIENT FULL LEGAL NAME], Date of Birth [DOB], residing at [ADDRESS] (“Patient”).
• Attending/Ordering Physician: [PHYSICIAN FULL NAME], Alabama Medical License No. [LICENSE #] (“Physician”).
Recitals:
A. Patient desires, in the event of cardiac or respiratory arrest, that no cardiopulmonary resuscitation (“CPR”) or advanced cardiac life support be attempted.
B. Physician, having consulted with Patient or Patient’s legally authorized representative, issues this medical order consistent with Alabama law and acceptable medical standards.
C. This Directive is intended to be honored by all health-care providers, facilities, and emergency medical services (“EMS”) personnel within the State of Alabama.
2. DEFINITIONS
For purposes of this Directive, the following terms shall have the meanings set forth below:
“ADPH” – the Alabama Department of Public Health or any successor agency.
“Advance Directive for Health Care” – a separate written instrument executed pursuant to Ala. Code § 22-8A-4 that appoints a health-care proxy and/or sets forth treatment preferences.
“CPR” – cardiopulmonary resuscitation, including chest compressions, defibrillation, artificial ventilation, advanced airway management, vasoactive medications, or other life-sustaining resuscitative measures.
“DNAR Identification” – (i) the original, unaltered copy of this Directive, or (ii) a properly issued ADPH-approved DNAR bracelet/necklace bearing Patient’s name and the words “DO NOT RESUSCITATE – ALABAMA.”
“Good-Faith Compliance” – actions taken in objective reliance upon the validity of this Directive without knowledge of its revocation, alteration, or suspension.
“Health-Care Provider” – any physician, nurse, paramedic, EMT, hospital, nursing facility, hospice, or other person or entity licensed, certified, or otherwise authorized by Alabama law to provide health-care services.
3. OPERATIVE PROVISIONS
3.1 Medical Order. The Physician hereby orders that, in the event Patient experiences cardiac or respiratory arrest, NO CPR, defibrillation, intubation, or other resuscitative measures shall be initiated or, if already initiated, shall be discontinued immediately.
3.2 Scope of Directive.
(a) This Directive applies in all health-care settings, including acute-care hospitals, long-term care facilities, outpatient centers, and during EMS transport within Alabama.
(b) Comfort-care measures (e.g., oxygen, pain relief, bleeding control) shall be provided as medically indicated and desired by Patient.
(c) This Directive does not affect the provision of other medically indicated treatments prior to cardiac or respiratory arrest, or Patient’s right to request such treatments.
3.3 Duration; Review. This Directive remains in force unless and until revoked under Section 3.4 or replaced by a subsequent DNAR order. Physician shall review the Directive (i) upon any material change in Patient’s condition, (ii) upon Patient request, and (iii) at least annually.
3.4 Revocation or Suspension.
(a) Patient or Patient’s legally authorized representative may revoke this Directive at any time by oral or written communication to any Health-Care Provider.
(b) Temporary suspension may be ordered by the treating physician where necessary to clarify Patient’s wishes or medical status.
(c) Upon revocation, all DNAR Identification shall be surrendered or destroyed, and providers shall document revocation in Patient’s medical record.
3.5 EMS Recognition. Pursuant to ADPH EMS protocol, EMS personnel shall honor this Directive upon (i) presentation of DNAR Identification, and (ii) verification that the Directive appears valid and unrevoked. If EMS personnel have reasonable doubt as to validity, they shall initiate resuscitation and contact Medical Control per protocol.
4. REPRESENTATIONS & WARRANTIES
4.1 Patient Representations. Patient represents that:
(a) Patient is at least nineteen (19) years of age and of sound mind, or, if incapable, this Directive is executed by [LEGAL REPRESENTATIVE NAME] (“Representative”) duly authorized under an Advance Directive for Health Care or durable power of attorney.
(b) Patient has had the opportunity to discuss the medical consequences of DNAR status with Physician and understands the same.
4.2 Physician Representations. Physician represents that:
(a) Physician has explained the nature of CPR and the consequences of a DNAR order to Patient/Representative in terms reasonably understandable to the layperson.
(b) The order is, in Physician’s clinical judgment, consistent with accepted medical standards and Patient’s preferences.
4.3 Survival. The representations and warranties herein shall survive execution and continue for the duration of this Directive.
5. COVENANTS & RESTRICTIONS
5.1 Patient Covenants. Patient/Representative shall:
(a) Maintain DNAR Identification on or near Patient at all times;
(b) Provide copies of this Directive to all treating Health-Care Providers; and
(c) Promptly inform Physician of any desire to modify or revoke this Directive.
5.2 Provider Obligations. Health-Care Providers receiving this Directive covenant to:
(a) Document receipt and acknowledgment in Patient’s medical record; and
(b) Adhere to the Directive in Good-Faith Compliance with State Health-Care Law.
5.3 Non-Delegation. No person may delegate or assign the authority to override this Directive except as expressly allowed under State Health-Care Law.
6. DEFAULT & REMEDIES
6.1 Events of Default. A default occurs if any Health-Care Provider knowingly fails to honor this Directive absent legal justification.
6.2 Notice & Opportunity to Cure. Upon learning of a potential default, the non-breaching party shall promptly notify the breaching party. The breaching party shall have an immediate obligation to cure by ceasing resuscitative efforts or otherwise bringing conduct into compliance.
6.3 Remedies. Without limiting other rights, Patient/Representative may seek:
(a) Injunctive relief compelling compliance with this Directive;
(b) Recovery of actual damages caused by willful misconduct or gross negligence; and
(c) Reasonable attorneys’ fees and costs incurred in enforcement.
7. RISK ALLOCATION
7.1 Indemnification – Provider Protection. Patient/Representative shall indemnify and hold harmless any Health-Care Provider who, in Good-Faith Compliance with this Directive, withholds or withdraws resuscitative measures, from and against any civil or criminal liability, except for acts of willful misconduct or gross negligence.
7.2 Limitation of Liability – Good-Faith Standard. No Health-Care Provider acting in Good-Faith Compliance with this Directive shall be liable for damages or subject to disciplinary action for honoring or failing to honor this Directive, as provided by Ala. Code § 22-8A-11.
8. DISPUTE RESOLUTION
8.1 Governing Law. This Directive shall be governed by and construed under the laws of the State of Alabama (“State Health-Care Law”), without regard to conflict-of-laws principles.
8.2 Forum Selection; Injunctive Relief. Any action arising under this Directive shall be brought exclusively in the state courts located in [COUNTY, AL]. Nothing herein limits Patient/Representative’s right to seek emergency injunctive relief to enforce this Directive.
[// GUIDANCE: Arbitration and jury-trial waivers are intentionally omitted per user metadata.]
9. GENERAL PROVISIONS
9.1 Amendment. This Directive may be amended only by execution of a new DNAR order consistent with State Health-Care Law.
9.2 Severability. If any provision of this Directive is held invalid, the remaining provisions shall remain in full force to the maximum extent permitted by law.
9.3 Integration. This Directive, together with any Advance Directive for Health Care or power of attorney previously executed by Patient, constitutes the entire agreement regarding resuscitation preferences and supersedes all prior DNAR orders.
9.4 Electronic Copies. Photostatic, facsimile, or electronically transmitted copies of this Directive shall be treated as originals; however, EMS personnel may require inspection of the original or DNAR Identification under ADPH protocol.
9.5 Counterparts. This Directive may be executed in multiple counterparts, each of which shall constitute an original and all of which together constitute one instrument.
10. EXECUTION BLOCK
10.1 Patient (or Representative) Signature
I, the undersigned Patient (or duly authorized Representative), declare that I have read this Directive, understand its meaning, and voluntarily execute it.
| Signature | Name (Print) | Date | Relationship (if Representative) |
|---|---|---|---|
| ________ | ______ | ___ | ___ |
10.2 Witness Attestation
We declare that the Patient (or Representative) signed this Directive in our presence. Each witness is at least 19 years of age, not related to Patient by blood, marriage, or adoption, not entitled to any portion of Patient’s estate, not financially responsible for Patient’s medical care, and not directly involved in providing medical services to Patient at the time of execution.
| Witness Signature | Name (Print) | Address | Date |
|---|---|---|---|
| ________ | ______ | ________ | ___ |
| ________ | ______ | ________ | ___ |
[// GUIDANCE: Pursuant to Ala. Code § 22-8A-4(b), either TWO witnesses or a Notary Public acknowledgment is required. If notarization is chosen, delete the witness table and insert a notary block.]
10.3 Physician Statement and Order
I am the attending/ordering physician for the above-named Patient and certify that the requirements of Alabama law for issuance of a DNAR order have been satisfied. I hereby direct that no resuscitative measures be undertaken in the event of cardiac or respiratory arrest.
| Physician Signature | Physician Name (Print) | Date | Phone |
|---|---|---|---|
| ________ | ______ | ___ | __ |
10.4 Facility / EMS Record (Optional)
Document Number: [FACILITY OR EMS USE]
Entered into Medical Record By: ___ Date: __
[// GUIDANCE:
1. Provide Patient with copies and encourage posting in a prominent location.
2. Offer ADPH-approved DNAR bracelets/necklaces to enhance EMS recognition.
3. Attach copies of any Advance Directive for Health Care or Healthcare Power of Attorney.
4. Review annually and upon any significant change in Patient’s health status.
]