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Applications & Forms
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The Maine EMS Comfort Care/DNR program has two different forms available, depending upon whether the patient has the capacity to make an informed decision.
The Comfort Care/DNR Directive is available for use by anyone over 18 years of age who is capable of making an informed decision. By completing the form, the person named on the form is directing EMS crews to not attempt resuscitation if the personís heart or breathing stops. The Comfort Care/DNR Directive form must be signed by a licensed physician, who attests that the person has the mental capacity to make an informed decision concerning DNR. A physician is under no obligation to sign the Comfort Care/DNR Directive form, but may do so if requested by the person whose name appears on the form.
The Comfort Care/DNR Order is used when the person named on the form does not have the capacity to make an informed decision (e.g., guardianship, surrogate). When completed and signed by the patientís physician and guardian/surrogate, the form documents a physician order to withhold resuscitation.
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