No CPR form

No CPR form

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In some situations, some people who are approaching the natural end of their lives or suffering from a life-limiting or life-threatening illness, may want to record their wish to not have cardiopulmonary resuscitation (CPR) or other emergency medical procedures provided by first responders or other health care providers if their heart or lungs suddenly stop.

In B.C., the No Cardiopulmonary Resuscitation (No CPR) form provides you and your physician or nurse practitioner with a legal option to order that no CPR be provided by health care providers and first responders. For the form to be valid, it must be signed by a consenting adult, either you or your substitute decision maker, and your physician or nurse practitioner. If you have a No CPR order that is visible and signed, you will not be given CPR by first responders or other health care providers. In home settings, people often put the order on their fridge so it can be easily seen.

For more information about the No CPR form, please contact your physician, nurse practitioner, or other health care provider.

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Create a No CPR order

If you want to record informed consent to refuse CPR in a medical emergency, it is encouraged that you discuss your decision with close family or friends, and then with your physician or nurse practitioner to see if writing a No CPR order is the recommended option. Making this decision can be difficult, and can depend on many unique facts and considerations in your life.

When you have made the decision to create a No CPR order, you will need to fill out the No CPR form (PDF, 591KB). You can also obtain a copy of the No CPR form from your physician's or nurse practitioner's office. Complete the patient portions of the form and have your physician or nurse practitioner complete the “physician/nurse practitioner” section.

Once completed, a copy of the No CPR order should remain with you and/or your next of kin providing care, your physician or nurse practitioner, and if applicable your community home care nursing services or residential care facility. Please read the information provided on the front and back of the No CPR order closely.

The BC Ambulance Service recommends that you wear a No CPR MedicAlert® bracelet or necklet so that ambulance personnel or other first responders can quickly tell a No CPR order exists. British Columbians who have a physician-signed No CPR order are eligible to participate in the MedicAlert® No CPR program and receive a free bracelet and necklet. For more information, visit MedicAlert® Products and Services or call MedicAlert®toll-free at 1-800-668-1507.

Printable PDF - No Cardiopulmonary Resuscitation (CPR) Form.

Cancel a No CPR order

If you wish to cancel the No CPR order after it has been signed by you and your physician or nurse practitioner, you should speak to your physician or nurse practitioner; tear up the signed No CPR form, stop wearing your MedicAlert® No CPR bracelet or necklet, and inform MedicAlert® of the update as soon as possible. If copies of the No CPR order were shared with your next of kin, your community home care nursing service, or your residential care facility, they should be informed of the canceled No CPR order as soon as possible.

For more information

For more information about advance care planning, including planned home deaths, see our Advance Care Planning health feature or visit Ministry of Health—Expected/Planned Home Deaths.