MONTANA DO NOT RESUSCITATE (DNR) DIRECTIVE
(Out-of-Hospital Provider Order & Advance Healthcare Directive)
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
- Appendix A – Optional Wallet Card / Bracelet Authorization
[// GUIDANCE: This template integrates Montana-specific “Comfort One” out-of-hospital DNR requirements, two-witness formalities, and EMS recognition language. Replace all bracketed text, delete guidance boxes, and confirm compliance with the most current Department of Public Health & Human Services (DPHHS) rules before finalizing.]
1. DOCUMENT HEADER
1.1 Title. Montana Do Not Resuscitate Directive and Out-of-Hospital Provider Order
1.2 Parties.
(a) “Patient” – [PATIENT LEGAL NAME], residing at [ADDRESS].
(b) “Authorized Agent” (if any) – [AGENT NAME], appointed under a valid Durable Power of Attorney for Health Care dated [DATE].
(c) “Attending Provider” – [PHYSICIAN / APRN / PA NAME], licensed in the State of Montana, License No. [NUMBER].
1.3 Recitals.
A. Patient, being of sound mind and at least eighteen (18) years of age, desires to exercise the right to refuse cardiopulmonary resuscitation (“CPR”) and related life-sustaining treatment in the event of cardiac or respiratory arrest.
B. Montana law and the DPHHS “Comfort One” program recognize written provider orders directing Emergency Medical Services (“EMS”) and other health-care providers to withhold resuscitative measures when presented with a valid DNR directive.
C. The Parties intend this Directive to be immediately effective upon execution, to remain in force until revoked pursuant to Section 3.7, and to be honored in all out-of-hospital and in-facility settings within Montana.
1.4 Effective Date & Governing Law. This Directive is effective as of [EFFECTIVE DATE] and shall be construed under the healthcare laws and public-health regulations of the State of Montana.
2. DEFINITIONS
For purposes of this Directive, capitalized terms have the meanings set forth below:
“Agent” – A person legally authorized by the Patient under a valid Durable Power of Attorney for Health Care to make healthcare decisions on the Patient’s behalf.
“Comfort One Identification” – A DPHHS-approved original DNR form, wallet card, or metal bracelet/necklace that signifies the existence of a valid out-of-hospital DNR order.
“CPR” – Cardiopulmonary resuscitation, including chest compressions, defibrillation, artificial ventilation, endotracheal intubation, and administration of cardiac drugs intended to restore cardiac or respiratory function.
“EMS Personnel” – Licensed emergency medical technicians, paramedics, or other pre-hospital responders operating under Montana EMS protocols.
“Good-Faith Compliance” – Actions taken in reasonable reliance upon the apparent validity of this Directive, absent gross negligence or willful misconduct.
“Healthcare Provider” – Any individual or facility licensed, certified, or otherwise authorized to provide medical or nursing services in Montana.
“Provider Order” – The written order executed by the Attending Provider in Section 10 confirming the Patient’s DNR status in accordance with Montana administrative rules.
3. OPERATIVE PROVISIONS
3.1 Directive Not to Resuscitate. In the event of cardiac or respiratory arrest, no person shall attempt CPR or advanced cardiac life support. Palliative and comfort-care measures (e.g., oxygen, pain management) shall be provided.
3.2 Scope of Applicability. This Directive applies:
(a) in all out-of-hospital settings within Montana;
(b) in any licensed healthcare facility within Montana; and
(c) to all EMS Personnel, Healthcare Providers, and bystanders who possess actual knowledge of this Directive.
3.3 Display & Identification. The Patient (or Agent) shall:
(a) maintain the original signed Directive in an easily accessible location;
(b) present a Comfort One Identification device when possible; and
(c) ensure copies are filed in the Patient’s medical record at each treating facility.
3.4 Transfer & Admission. Receiving facilities must promptly place this Directive in the Patient’s chart and flag the Patient as DNR upon admission or transfer.
3.5 Do-Not-Intubate (DNI) & Related Limits. Intubation, mechanical ventilation, or any invasive airway support is expressly refused.
3.6 Artificial Nutrition & Hydration. [SELECT ONE:]
☐ Refused ☐ Accepted ☐ Accepted subject to the following conditions: [CONDITIONS].
3.7 Revocation. The Patient (or Agent) may revoke this Directive at any time by:
(a) communicating the intent to revoke to any Healthcare Provider;
(b) destroying the original Directive and all copies; or
(c) removing and destroying any Comfort One Identification device.
3.8 Conditions Subsequent. If the Patient becomes pregnant and continuation of life-sustaining treatment is required under applicable law to preserve fetal life, this Directive shall be suspended to the minimum extent mandated.
4. REPRESENTATIONS & WARRANTIES
4.1 Patient Representations.
(a) Capacity. Patient affirms full decisional capacity and comprehension of medical consequences.
(b) Voluntariness. Execution is free from coercion or undue influence.
(c) Completeness. Patient has disclosed all relevant advance directives and powers of attorney to the Attending Provider.
4.2 Provider Representations.
(a) Clinical Discussion. Provider has discussed diagnosis, prognosis, and the nature of resuscitative efforts with the Patient/Agent.
(b) Good-Faith Medical Judgment. Provider believes that honoring this Directive complies with professional standards and Montana law.
4.3 Survival. Representations and warranties survive execution and revocation only to the extent necessary to enforce Good-Faith Compliance immunity.
5. COVENANTS & RESTRICTIONS
5.1 Patient/Agent Covenants.
(a) Notice of Revocation. Promptly inform all Healthcare Providers of any revocation.
(b) Periodic Review. Review this Directive at least annually or upon significant change in health status.
5.2 Provider Covenants.
(a) Recordkeeping. Maintain this Directive (or a copy) in the Patient’s permanent medical record.
(b) EMS Notification. Transmit a copy to transporting EMS personnel during inter-facility transfers.
5.3 Restrictions on Modification. No handwritten alteration is valid unless separately initialed by the Patient and Attending Provider with date-stamp.
6. DEFAULT & REMEDIES
6.1 Events of Default.
(a) Unauthorized Resuscitation. Performance of CPR contrary to Section 3.1.
(b) Failure to Honor Revocation. Continuing to withhold resuscitation after valid revocation.
6.2 Notice & Cure. Upon discovery of a default, the non-defaulting party shall provide prompt notice. If the default is capable of cure (e.g., removing erroneous DNR status from chart), the defaulting party shall cure within a reasonable time.
6.3 Remedies.
(a) Injunctive Relief. The Patient or Agent may seek emergency injunctive relief compelling compliance with this Directive.
(b) No Monetary Damages Against Patient. Healthcare Providers shall have no recourse in damages against the Patient for exercising rights herein.
6.4 Attorneys’ Fees. In any action to enforce this Directive, the prevailing party is entitled to reasonable attorneys’ fees and costs.
7. RISK ALLOCATION
7.1 Indemnification (Provider Protection). The Patient (and estate) agrees to indemnify and hold harmless Healthcare Providers and EMS Personnel from any claim, cost, or liability arising out of Good-Faith Compliance with this Directive, except to the extent of gross negligence or willful misconduct.
7.2 Limitation of Liability (Good-Faith Standard). No Healthcare Provider or EMS Personnel acting in Good-Faith Compliance shall be liable for civil, criminal, or administrative penalties for withholding or withdrawing resuscitative measures pursuant to this Directive.
7.3 Insurance. Providers shall maintain, at their sole expense, professional liability insurance in amounts required by Montana law.
7.4 Force Majeure. Providers are excused from performance where compliance is impossible due to circumstances beyond reasonable control (e.g., mass-casualty incident overwhelming EMS resources).
8. DISPUTE RESOLUTION
8.1 Governing Law. All matters arising under this Directive are governed by the healthcare laws and public-health regulations of the State of Montana, without regard to conflict-of-law principles.
8.2 Forum Selection. Not applicable (health-care directive).
8.3 Arbitration & Jury Waiver. Not applicable.
8.4 Injunctive Relief Preservation. Nothing herein limits the right of any party to seek injunctive or declaratory relief from a court of competent jurisdiction to enforce or clarify this Directive.
9. GENERAL PROVISIONS
9.1 Amendment & Waiver. Any amendment must be in writing, signed, dated, and witnessed as required for an original execution. No waiver of rights shall be inferred from partial performance.
9.2 Assignment. This Directive is personal to the Patient and may not be assigned.
9.3 Successors & Assigns. This Directive binds the Patient’s heirs, executors, and personal representatives and inures to the benefit of all Healthcare Providers who rely hereon.
9.4 Severability. If any provision is held invalid, the remaining provisions shall remain enforceable to the fullest extent permitted.
9.5 Integration. This Directive constitutes the entire agreement on the subject matter and supersedes all prior DNR instructions, except any separate durable power of attorney for health care, which shall be construed consistently herewith.
9.6 Counterparts & Electronic Signatures. This Directive may be executed in counterparts and by electronic signatures to the extent permitted by Montana law; all counterparts constitute one instrument.
10. EXECUTION BLOCK
[// GUIDANCE: Two adult witnesses OR a notary is required under Montana’s advance directive formalities. Witnesses may not be (i) providing direct care, (ii) entitled to inherit, or (iii) financially responsible for the Patient’s care.]
10.1 Patient / Agent Signature
I, [PRINT NAME], being of sound mind, declare that I have read and understand this Directive, and that it accurately reflects my wishes.
Signature: _____ Date: _______
10.2 Attending Provider Confirmation (Provider Order)
I have discussed the medical implications of a Do Not Resuscitate order with the Patient/Agent identified above and, based on informed consent, hereby issue a DNR Provider Order consistent with Montana “Comfort One” protocols.
Provider Signature: _____
Printed Name & Credentials: _____
License No.: ___ Date: ____
10.3 Witness Attestation
We declare that the Patient signed or acknowledged this Directive in our presence, appears to be of sound mind and acting voluntarily, and that we meet the statutory qualifications to serve as witnesses.
Witness #1 Signature: ____ Date:
Printed Name & Address: _________
Witness #2 Signature: ____ Date:
Printed Name & Address: _________
––– OR –––
10.4 Notary Acknowledgment
State of Montana )
County of [COUNTY] ) ss.
On [DATE] before me, [NOTARY NAME], a Notary Public, personally appeared [NAME(S)], who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to this instrument, and acknowledged that he/she/they executed the same for the purposes therein contained.
Notary Public Signature: _____
My Commission Expires: _______ [Seal]
11. APPENDIX A – OPTIONAL WALLET CARD / BRACELET AUTHORIZATION
[// GUIDANCE: Cut on dotted line and carry with identification.]
MONTANA DNR – COMFORT ONE
Patient: [NAME] DOB: [DATE]
Provider: [PROVIDER NAME & PHONE]
Effective Date: [DATE] Expires: None unless revoked
NO CPR • NO INTUBATION
Comfort-care measures only
If found without pulse or respiration, DO NOT RESUSCITATE.
[// GUIDANCE: End of template. Conduct a final consistency check: defined terms, section numbering, and placeholders.]