NEW MEXICO EMERGENCY MEDICAL SERVICES

DO-NOT-RESUSCITATE (DNR) ORDER & MEDICAL DIRECTIVE

[// GUIDANCE: Print on bright-pink paper or laminate for maximum EMS recognition under N.M. practice.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1.1 Parties.
 (a) “Patient”: [PATIENT NAME], DOB [DATE OF BIRTH], last four SSN [XXXX].
 (b) “Authorizing Clinician”: [PHYSICIAN/NP/PA NAME], NM License No. [LICENSE #].

1.2 Recitals.
 (a) WHEREAS, Patient, being of sound mind (or through an authorized Surrogate Decision Maker), desires to forgo resuscitative measures in the event of cardiopulmonary arrest;
 (b) WHEREAS, New Mexico’s Uniform Health-Care Decisions Act, N.M. Stat. Ann. § 24-7A-1 et seq., and corresponding EMS Bureau protocols authorize EMS-recognized DNR orders; and
 (c) WHEREAS, the Authorizing Clinician, having discussed prognosis, alternatives, and consequences with Patient (or Surrogate), is willing to issue medical orders consistent herewith.

1.3 Effective Date. This Directive is effective as of [EFFECTIVE DATE] (the “Effective Date”).

1.4 Governing Law. This Directive shall be governed by the health-care laws of the State of New Mexico.

II. DEFINITIONS

“Advanced Directive” – A written instruction, such as this Directive, recognized under New Mexico law and relating to the provision of health care when the Patient lacks capacity.

“DNR Order” – A medical order directing that no cardiopulmonary resuscitation (“CPR”), advanced cardiac life support, or related invasive airway management be attempted if the Patient experiences cardiopulmonary arrest.

“EMS Personnel” – Licensed emergency medical responders, emergency medical technicians, paramedics, or other personnel certified under 7.27.2 NMAC.

“Good-Faith Standard” – The standard under which Health-Care Providers acting in reasonable reliance on this Directive are immune from civil or criminal liability.

“Health-Care Provider” – Any person licensed, certified, or otherwise authorized to administer health care, including EMS Personnel, hospitals, and long-term-care facilities.

“Surrogate Decision Maker” – A person authorized under N.M. Stat. Ann. § 24-7A-1 et seq. to make health-care decisions on the Patient’s behalf.

III. OPERATIVE PROVISIONS

3.01 Medical Directive.
 (a) No resuscitative efforts, including CPR, defibrillation, advanced airway management, or cardiac drugs, shall be initiated if the Patient is found apneic or pulseless.
 (b) Comfort-focused treatment (e.g., oxygen, pain relief, suctioning) is authorized and encouraged.

3.02 Scope & Applicability.
 (a) This Directive applies in all health-care settings, including but not limited to residences, ambulances, emergency departments, hospitals, and long-term-care facilities.
 (b) EMS Personnel presented with this Directive—or a legible copy, electronic image, or NM-approved DNR medallion—shall honor it pursuant to EMS protocols.

3.03 Revocation.
 (a) Patient (or Surrogate) may revoke this Directive at any time by:
  (i) destroying the document,
  (ii) making a written statement of revocation, or
  (iii) orally communicating revocation to Health-Care Providers.
 (b) Upon revocation, providers shall document the revocation in the medical record and resume full resuscitative measures.

3.04 Renewal & Review.
 (a) Recommended review every [REVIEW_INTERVAL, e.g., 12] months or upon material change in Patient’s condition.
 (b) Authorizing Clinician must re-sign after each substantive amendment.

3.05 Documentation & Display.
 (a) Original should accompany Patient at all times or be affixed to the head of the bed or refrigerator door when at home.
 (b) Facility copies shall be filed prominently in Patient’s chart under “Code Status.”

IV. REPRESENTATIONS & WARRANTIES

4.01 Patient Capacity. Patient affirms having decision-making capacity at execution, or that a duly authorized Surrogate executes on Patient’s behalf.

4.02 Voluntariness. Execution is voluntary, free of duress, coercion, or undue influence.

4.03 Accuracy of Information. All identifying information provided herein is true, complete, and correct to the best of Patient’s (or Surrogate’s) knowledge.

4.04 Clinician Authority. Authorizing Clinician represents possession of a current, unrestricted NM license permitting issuance of medical orders.

4.05 Survival. The warranties in this Article IV survive execution and remain effective until revocation or Patient’s death.

V. COVENANTS & RESTRICTIONS

5.01 Notification. Patient (or Surrogate) shall notify future treating clinicians of the existence of this Directive.

5.02 Consistency with Prior Instruments. Patient covenants that any prior advance directive or POLST form inconsistent with this Directive is either revoked or superseded hereby.

5.03 Changes in Condition. Authorizing Clinician shall reassess the appropriateness of this Directive upon a material change in Patient’s medical condition.

VI. DEFAULT & REMEDIES

6.01 Failure to Honor. Should any Health-Care Provider fail to comply with this Directive:
 (a) Patient (or Surrogate) may seek injunctive relief to enforce the Directive;
 (b) Provider’s liability shall be determined under applicable New Mexico statutes; and
 (c) Prevailing party may recover reasonable attorney fees and costs.

6.02 Good-Faith Exception. No remedy shall lie against a Provider acting in good-faith reliance on an apparently valid revocation or superseding medical order.

VII. RISK ALLOCATION

7.01 Indemnification (Provider Protection). Patient (or Surrogate) agrees to indemnify and hold harmless Health-Care Providers, including EMS Personnel, from any civil liability, claim, or cost arising out of good-faith compliance with this Directive.

7.02 Limitation of Liability (Good-Faith Standard). In no event shall any Health-Care Provider be liable for damages beyond those incurred through gross negligence or willful misconduct.

7.03 Insurance. Nothing herein shall impair available professional liability insurance.

7.04 Force Majeure. Non-compliance occasioned by circumstances outside a Provider’s reasonable control (e.g., natural disaster, mass-casualty incident) shall not constitute breach.

VIII. DISPUTE RESOLUTION

8.01 Governing Law. This Directive shall be interpreted in accordance with New Mexico substantive health-care law.

8.02 Forum Selection. Any proceeding to enforce or interpret this Directive shall be brought in a court of competent jurisdiction in the State of New Mexico.

8.03 Injunctive Relief. The parties acknowledge that immediate equitable relief may be necessary to enforce Patient’s wishes and preserve the status quo.

[// GUIDANCE: Arbitration and jury waiver intentionally omitted per metadata (“not_applicable”).]

IX. GENERAL PROVISIONS

9.01 Amendment & Waiver. No amendment or waiver is effective unless executed in writing by Patient (or Surrogate) and Authorizing Clinician.

9.02 Assignment. Rights under this Directive are personal to Patient and may not be assigned.

9.03 Successors & Assigns. This Directive binds and benefits Patient’s estate, heirs, and any Surrogate Decision Maker duly appointed under New Mexico law.

9.9.03 Successors & Assigns (cont.). This Directive binds and benefits Patient’s estate, heirs, and any duly authorized Surrogate Decision Maker.

9.04 Severability. If any provision of this Directive is held invalid or unenforceable, the remaining provisions shall remain in full force and effect and shall be construed to carry out the Patient’s intent.

9.05 Integration. This document constitutes the entire DNR directive and supersedes all prior oral or written statements regarding resuscitative measures, except to the extent expressly incorporated herein.

9.06 Counterparts. This Directive may be executed in multiple counterparts, each of which shall be deemed an original and all of which together constitute one instrument.

9.07 Electronic Signatures. Signatures executed via secure electronic means compliant with the New Mexico Uniform Electronic Transactions Act shall be deemed original for all purposes.

X. EXECUTION BLOCK

A. Patient / Surrogate

B. Witnesses
[// GUIDANCE: New Mexico UHCDA requires either (i) two adult witnesses OR (ii) a notary acknowledgment for advance directives. Use whichever is preferred by the executing party.]

C. Notary Public (optional but recommended if witness signatures unavailable)

State of New Mexico
County of [COUNTY]

On this [DATE], before me, the undersigned Notary Public, personally appeared [NAME(S)], proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) are subscribed herein, and acknowledged that they executed the same for the purposes stated.

Notary Public: _____
My Commission Expires: ___

D. Authorizing Clinician

E. EMS Confirmation (for healthcare facility use)

☐ Original or copy placed in Patient’s chart.
☐ Bright-pink form/lamination verified.
☐ EMS notified of DNR status through ePCR upload on [DATE].

[// GUIDANCE:
1. File this Directive prominently and provide copies to all treating providers.
2. Review after any substantial change in Patient’s diagnosis, prognosis, or treatment preferences.
3. Consider integration with POLST/MOST if broader treatment limitations are desired.
4. Ensure additional statutory requirements—for example, Spanish-language translation under federal accessibility rules—are met as needed.]