DNR Form

PRE HOSPITAL DO-NOT-RESUSCITATE (DNR) REQUEST FORM INFORMATION

This form must be witnessed by someone that will not benefit from the patients WILL

*Please provide a total of 3 forms filled out.

Form 1: Is the Patients Copy Form

2: Deliver to Patient Medical Provider Form

3: Deliver to Phillips County EMS if Phillips County Resident

409 E St
Phillipsburg ,
KS
67661
Fax: 785-543-6806

Monday-Friday
8:00am - 5:00pm
Director
Pete Rogers
Assistant Director/Office Manager
Lisa Caps
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