Ministry of the
Solicitor General

OFM - Do Not Resuscitate

DNR Confirmation Form

When completed, this form provides direction to both paramedics and firefighters with respect to what patient care interventions may be initiated for patients experiencing respiratory or cardiac arrest.

This form cannot be printed or filled “on-line” due to the unique serial number that is pre-printed on each form.

Form Number: 4519-45 (08/01)
Catalogue Number: 7530-5678

To obtain a supply of DNR Confirmation Forms, please submit a request via email to Ontario Shared Services (OSS) at using the Ministry of Health - Forms Order Request.