COLORADO CPR DIRECTIVE
(Do-Not-Resuscitate / “DNR” Order)
[// GUIDANCE: This template is drafted to comply with Colorado’s “Colorado Medical Treatment Decision Act,” C.R.S. §§ 15-18.6-101 et seq., and current Colorado Department of Public Health & Environment (“CDPHE”) EMS protocols. Customize bracketed fields, remove guidance comments before final execution, and confirm compliance with any future statutory or regulatory changes.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
1.1 Title. Colorado CPR Directive (Do-Not-Resuscitate Order).
1.2 Parties.
(a) “Patient”: [INSERT LEGAL NAME OF PATIENT]
(b) “Agent”: [INSERT NAME OF AGENT, IF ANY, under Patient’s valid Medical Durable Power of Attorney]
(c) “Attending Provider”: [INSERT NAME OF PHYSICIAN / ADVANCED PRACTICE NURSE]
(d) “Health-Care Providers” & “EMS Personnel”: Collectively, any individual or entity licensed or authorized to provide medical care or emergency medical services within the State of Colorado.
1.3 Recitals.
WHEREAS, Patient desires, in advance, to refuse cardiopulmonary resuscitation (“CPR”) in the event of cardiac or respiratory arrest; and
WHEREAS, Colorado law authorizes competent adults (or their authorized Agents) to execute a written CPR Directive, C.R.S. §§ 15-18.6-101 et seq.; and
WHEREAS, Attending Provider has explained the medical implications of a CPR Directive, and Patient knowingly and voluntarily elects to execute this Directive;
NOW, THEREFORE, Patient hereby elects to be subject to this Colorado CPR Directive (“Directive”), effective as of the Effective Date defined below.
1.4 Effective Date. This Directive becomes legally operative upon the latest date of signature in Section 10 (Execution Block) (“Effective Date”) and remains in effect until revoked pursuant to Section 3.9.
1.5 Governing Law. This Directive is governed by the laws of the State of Colorado and applicable federal health-care laws.
2. DEFINITIONS
For purposes of this Directive, capitalized terms have the meanings set forth below. Terms listed alphabetically.
2.1 “Agent” – The individual appointed in a valid Medical Durable Power of Attorney to make health-care decisions on Patient’s behalf.
2.2 “Cardiac or Respiratory Arrest” – The cessation of cardiac mechanical activity or absence of spontaneous respirations necessitating CPR.
2.3 “Comfort-Focused Care” – Medical or nursing care intended to alleviate pain or maintain comfort without attempting resuscitation or cure.
2.4 “CPR” – All cardiopulmonary resuscitative measures, including chest compressions, defibrillation, assisted ventilation, endotracheal intubation, vasoactive drug administration, or any other advanced cardiac life support (“ACLS”) intervention.
2.5 “Directive” – This Colorado CPR Directive, including all duly executed amendments or revocations.
2.6 “EMS Personnel” – Emergency medical technicians, paramedics, or other licensed pre-hospital providers operating under CDPHE protocols.
2.7 “Good Faith” – Honest intention to act without malice, negligence, or the intent to defraud, consistent with reasonable medical standards.
2.8 “Health-Care Provider” – Any person or entity licensed, certified, or otherwise authorized to provide medical or health-care services in Colorado.
3. OPERATIVE PROVISIONS
3.1 Statement of Intent. Patient expressly directs that no CPR be attempted in the event of Cardiac or Respiratory Arrest.
3.2 Scope of Withheld Interventions. CPR (as defined), including but not limited to chest compressions, defibrillation, endotracheal intubation, manual or mechanical ventilation, and administration of ACLS drugs, SHALL NOT be initiated.
3.3 Permitted Medical Interventions. Unless otherwise specified in Section 3.4, Patient DOES consent to:
(a) Comfort-Focused Care;
(b) Hemorrhage control;
(c) Analgesia, antipyretics, or anxiolytics;
(d) Oxygen for comfort;
(e) Nutritional support and hydration as tolerated.
3.4 Optional Limitations (Check if Applicable).
☐ No artificial nutrition or hydration.
☐ No antibiotics.
☐ Other: [DESCRIBE].
3.5 EMS Recognition. Pursuant to CDPHE EMS protocols, EMS Personnel presented with (i) an original or unaltered copy of this Directive, (ii) a valid Colorado-approved DNR bracelet or necklace, or (iii) other CDPHE-authorized device, SHALL honor this Directive and withhold CPR.
3.6 Documentation & Disclosure.
(a) Patient or Agent shall provide copies of this Directive to Health-Care Providers and maintain the original in an easily accessible location.
(b) Attending Provider shall document the existence of this Directive in Patient’s medical record.
3.7 Duration. This Directive remains effective indefinitely unless revoked or superseded.
3.8 Amendment. Patient (or Agent) may amend this Directive in writing, signed, witnessed/notarized per Section 10. Any amendment becomes effective upon execution and delivery to Health-Care Providers.
3.9 Revocation. Patient (or Agent) may revoke this Directive at any time by:
(a) A written, dated, and signed revocation delivered to Health-Care Providers;
(b) Physical destruction of all originals and copies; or
(c) Oral expression of intent to revoke, documented by two disinterested witnesses or a Health-Care Provider. Revocation is effective immediately upon communication to Health-Care Providers or EMS Personnel.
3.10 Conflicts. If another advance directive conflicts with this Directive, the most recent document controls unless expressly stated otherwise.
4. REPRESENTATIONS & WARRANTIES
4.1 Patient Representations.
(a) Capacity. Patient affirms possessing decision-making capacity at the time of execution.
(b) Voluntariness. Execution is voluntary, free from duress, coercion, fraud, or undue influence.
(c) Full Disclosure. Patient acknowledges discussion with Attending Provider regarding risks, benefits, and alternatives to CPR.
4.2 Provider Representations.
(a) Professional Assessment. Attending Provider certifies that Patient understands the medical consequences of refusing CPR.
(b) Compliance. Attending Provider will enter this Directive into Patient’s medical record and instruct facility staff accordingly.
4.3 Survival. The representations in this Section survive the revocation or termination of the Directive with respect to actions taken while the Directive was in force.
5. COVENANTS & RESTRICTIONS
5.1 Patient Covenants. Patient (or Agent) shall:
(a) Inform future Health-Care Providers of this Directive;
(b) Wear or carry CDPHE-approved DNR identification if desired to enhance EMS recognition.
5.2 Provider Covenants. Health-Care Providers and EMS Personnel shall:
(a) Act in Good Faith compliance with this Directive;
(b) Provide Comfort-Focused Care;
(c) Promptly document any refusal or inability to honor this Directive and transfer Patient to another provider willing to comply.
6. DEFAULT & REMEDIES
6.1 Events of Default. Any initiation of CPR in violation of this Directive constitutes a “Default” under this Section.
6.2 Notice & Cure. Because CPR is time-sensitive, no cure period exists; however, subsequent compliance with Patient’s wishes—including termination of resuscitative efforts—mitigates liability under Section 7.
6.3 Remedies. In addition to statutory remedies, parties are entitled to:
(a) Injunctive Relief. Immediate court order enforcing non-resuscitation;
(b) Actual Damages. Limited by the Good Faith standard under Section 7.
7. RISK ALLOCATION
7.1 Indemnification – Provider Protection. Patient (and Patient’s estate) SHALL DEFEND, INDEMNIFY, AND HOLD HARMLESS all Health-Care Providers and EMS Personnel from and against any loss, claim, or liability arising from Good Faith compliance with—or reliance upon—this Directive.
7.2 Liability Cap – Good Faith Standard. Consistent with C.R.S. § 15-18.6-104, any Health-Care Provider or EMS Personnel acting in Good Faith reliance on this Directive SHALL NOT incur civil or criminal liability or be subject to professional disciplinary action.
7.3 Insurance. Providers may rely on their existing professional liability coverage; no additional insurance is required under this Directive.
7.4 Force Majeure. Non-performance caused by events beyond Provider’s reasonable control (e.g., destruction or unavailability of the Directive) shall not constitute a Default if Provider acted in Good Faith.
8. DISPUTE RESOLUTION
8.1 Governing Law. Colorado law controls interpretation and enforcement of this Directive.
8.2 Forum Selection / Arbitration / Jury Waiver. Not applicable. Any necessary judicial proceedings shall follow Colorado probate or district court jurisdiction as provided by statute.
8.3 Injunctive Relief. Courts of competent jurisdiction may issue equitable relief enforcing the terms of this Directive.
9. GENERAL PROVISIONS
9.1 Amendment & Waiver. Any amendment must comply with Section 3.8. No oral waiver of any provision is effective.
9.2 Assignment. Rights and obligations hereunder are personal to Patient and may not be assigned.
9.3 Successors & Assigns. The terms bind Patient’s heirs, personal representatives, and permitted assigns.
9.4 Severability. If any provision is invalid or unenforceable, the remaining provisions remain in full force, and the invalid portion shall be conformed to law to effectuate intent.
9.5 Integration. This Directive constitutes the entire agreement regarding CPR decisions and supersedes all prior inconsistent directives concerning CPR.
9.6 Counterparts & Electronic Signatures. This Directive may be executed in counterparts, each deemed an original. Facsimile, PDF, or compliant electronic signatures are as effective as originals to the extent permitted by C.R.S. § 24-71.3-101 et seq.
10. EXECUTION BLOCK
[// GUIDANCE: Colorado requires EITHER (i) a licensed physician/advanced practice nurse AND one adult witness, OR (ii) acknowledgement before a notary public. Strike inapplicable signature lines.]
10.1 PATIENT (or Agent) SIGNATURE
I, the undersigned Patient (or duly authorized Agent), have read and understand this Colorado CPR Directive and voluntarily execute it.
Signature: ____
Print Name: ____
Date: _______
☐ Agent Signature (if applicable)
Signature: ____
Print Name & Authority: ____
Date: ___
10.2 ATTENDING PROVIDER CERTIFICATION
I affirm that I have discussed the risks and benefits of CPR with the Patient (or Agent) and that the Patient has decision-making capacity or that the Agent is duly authorized.
Signature: ____
Print Name: ____
License No.: ____
Date: _______
10.3 WITNESS ATTESTATION
I am at least 18 years old, not related to the Patient by blood, marriage, or adoption, not entitled to any portion of the Patient’s estate, and not financially responsible for the Patient’s medical care. I witnessed the Patient (or Agent) sign this Directive and believe the Patient (or Agent) to be of sound mind and acting voluntarily.
Witness Signature: ___
Print Name: ____
Date: ______
Address: _______
10.4 NOTARY ACKNOWLEDGMENT (optional – strike if not used)
State of Colorado )
County of ____) ss.
The foregoing instrument was acknowledged before me this ___ day of _, 20_, by _____ (Patient / Agent).
Notary Public Signature: ___
Print Name: ____
My Commission Expires: ___
Notary Seal:
[// GUIDANCE:
1. Provide copies to the Patient, Agent, Attending Provider, primary health-care facility, and place near the Patient’s bed or chart.
2. For enhanced EMS recognition, advise Patient to obtain a state-approved DNR bracelet or necklace through a licensed vendor.
3. Review statutory requirements periodically; Colorado regulations or EMS protocols may update form or signature requirements.]