Arkansas DNR Orders: Formats, EMS Response, and Revocation

An Arkansas DNR order tells emergency responders and healthcare providers not to attempt CPR if your heart stops or you stop breathing. To be valid in Arkansas, it has to be issued by your attending physician and appear in one of three formats approved by the Arkansas Department of Health: state-approved DNR identification (such as a bracelet or card), an oral order the physician gives directly to EMS at the scene, or a written order on a form that meets Department of Health requirements.¹ The rules live in Arkansas Code §§ 20-13-901 through 20-13-908 and in regulations set by the State Board of Health.

One thing to be clear on before going further: a DNR is narrow. It addresses CPR only. It does not speak to ventilators, feeding tubes, antibiotics, or pain management. If you want your wishes covered on any of those, you need a different document, discussed further down.

The Three Valid Formats

Arkansas gives equal legal weight to all three formats. Whichever one is present, EMS personnel other than physicians are required to follow the DNR protocol.¹

DNR Identification approved by the Arkansas Department of Health, such as a bracelet or card, that visually signals your status.
An oral Do Not Resuscitate order communicated directly by a physician to EMS personnel at the scene.
A written physician order on a form prescribed by the Department of Health.

Only your attending physician can issue the order.² The written form must contain the words “DNR” or “No Code” (or similar language), the physician’s signature, and a date.³ A form the physician creates themselves is still valid as long as it meets those requirements. The statute authorizing EMS to follow these orders applies only to adult patients in the prehospital setting.⁴

When EMS Will and Won’t Follow the Order

When responders arrive and find a patient in cardiac or respiratory arrest with a valid EMS/DNR, they follow their provider’s DNR implementation protocol. Two built-in default rules protect patients when the picture is not clean:

If there is any doubt about whether the order is genuine, EMS must resuscitate.
If family members or others at the scene dispute the order, EMS should contact the attending physician or their EMS medical control for guidance.

Both rules run in the same direction: when in doubt, keep the patient alive.⁵

You Can Override Your Own DNR

This is the protection most families do not know about. Signing a DNR does not lock you into that choice. If you are able to communicate and you tell EMS you want to be resuscitated, EMS is not authorized to follow the order, no matter what the paperwork says.⁴ Your spoken wishes in the moment override the signed document.

The same is true after you reach a healthcare facility. If you arrive with DNR Identification, you or your healthcare proxy can remand (cancel) the order by written or oral statement.¹

Revoking a DNR Permanently

You or your attending physician can revoke an EMS/DNR at any time and by any method.² There is no special form. Tell your physician you want the order removed and the physician takes it out of the record.

If you revoke, destroy any physical identification, cards, or bracelets tied to the order. Leaving them in circulation risks EMS personnel treating the order as still active in a future emergency. If what you actually want is to change the scope of the order rather than cancel it, the cleaner path is to revoke the existing order and have your attending physician issue a new one with updated terms.

What Hospitals and Physicians Must Do

Once you reach a hospital or other healthcare facility with a valid DNR, the attending physician and staff are expected to honor it. Section 20-13-904 addresses this directly for patients received from EMS with valid DNR Identification: unless you or your healthcare proxy cancel the order, the facility follows it.¹

If a physician or facility receiving you from EMS is unable or unwilling to follow the order, Arkansas law requires them to take all reasonable steps to transfer you to a physician or facility that will.¹ The statute’s “all reasonable steps” language means more than a token effort: identifying a receiving provider, confirming capacity and willingness, and handing over relevant medical records.

No One Can Require You to Have One

Arkansas law prohibits physicians, healthcare facilities, healthcare service plans, insurers, and self-insured benefit plans from requiring a person to have DNR Identification as a condition of receiving healthcare services or insurance coverage. Your decision to execute a DNR, or not to, cannot be held against you by any provider or insurer.

Documents That Go Beyond a DNR

Because a DNR only addresses CPR, patients who want to cover other end-of-life decisions typically pair it with one or more of the following.

Living Will

Any competent adult 18 or older can execute a declaration governing the withholding or withdrawal of life-sustaining treatment. The declaration must be signed by you (or by someone at your direction) and either witnessed by two people or notarized.⁶ A living will covers a broader range of end-of-life decisions than a DNR and takes effect when you become incapacitated and cannot communicate. A physician or provider who receives a copy must place it in your medical record.

Healthcare Proxy

A healthcare proxy, called an attorney-in-fact under Arkansas’s durable power of attorney for healthcare, is a person 18 or older whom you appoint to make healthcare decisions for you. Under Arkansas law the proxy has authority to make treatment decisions for a qualified patient, including withholding or withdrawing life-sustaining procedures, in consultation with the attending physician.⁶ The proxy can also remand a DNR on your behalf at the point of care.¹

AR POLST

Arkansas has adopted the Physician Orders for Life-Sustaining Treatment paradigm. The AR POLST is a distinctive pink document that translates a patient’s goals and treatment preferences into a physician order that travels with the patient across healthcare settings.⁷ Unlike a standard DNR, a POLST can address CPR preferences alongside ventilators, feeding tubes, and other interventions. It is designed for patients who are seriously ill or frail and carries the force of a medical order. For patients with more complex end-of-life preferences, a POLST often provides more complete coverage than a standalone DNR.

DNRs From Other States

Arkansas Code § 20-13-907 includes a reciprocity provision for DNR orders issued in other states. How that plays out in a specific situation depends on how closely the out-of-state order tracks Arkansas’s requirements, but the existence of the section means Arkansas does not automatically disregard out-of-state orders. If you split time between states or travel often, ask your physician about portability and consider obtaining Arkansas-specific documentation so there is no ambiguity if EMS is called.

1
Justia. Arkansas Code 20-13-904 – Adherence to Do Not Resuscitate Protocol – Transfer of Patients
2
Legal Information Institute. Arkansas Code 016.24.05-003 – Rules for Emergency Medical Services Do Not Resuscitate
3
Arkansas Code of Rules. 20 CAR 82-102 – Requirements and Provisions for the Emergency Medical Services Do Not Resuscitate Order Form
4
Justia. Arkansas Code 20-13-903 – Authorization to Follow Emergency Medical Services Do Not Resuscitate Orders in the Prehospital Setting
5
Code of Arkansas Rules. 20 CAR 82-104 – Implementation Procedure
6
Justia. Arkansas Code 20-17-202 – Declaration Relating to Use of Life-Sustaining Treatment
7
Arkansas Department of Health. POLST – Forms and Directions