Kentucky Do Not Resuscitate (DNR) Form

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Kentucky Do Not Resuscitate (DNR) Form

A Kentucky do not resuscitate form is completed by a patient or their health surrogate to instruct emergency medical services not to perform CPR if their heart or breathing stops. The patient must keep this form or a DNR bracelet somewhere visible so EMS staff know not to resuscitate. A DNR form does not prevent other non-resuscitative medical care

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Last updated July 21st, 2025

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A Kentucky do not resuscitate form is completed by a patient or their health surrogate to instruct emergency medical services not to perform CPR if their heart or breathing stops. The patient must keep this form or a DNR bracelet somewhere visible so EMS staff know not to resuscitate. A DNR form does not prevent other non-resuscitative medical care

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Signing Requirements

A DNR must be signed by the patient or, if the patient is incapacitated or a minor, by their legal health care surrogate.

Facility Transfers

The form includes a verification section that medical staff will complete when the patient is transferred in and out of a health care facility. This allows both sending and receiving facilities to recognize the legitimacy of a DNR order for out-of-hospital situations.

Medical Orders for Scope of Treatment (MOST) – In Kentucky, patients may choose to have a physician complete a MOST form, which includes a DNR order and allows patients to indicate other medical intervention preferences.

Do Not Resuscitate (Preview)