Kentucky EMS Forms
Kentucky EMS Do Not Resuscitate (DNR) Form
Kentucky law forbids the EMS from recognizing any DNR request unless it's specifically spelled out on the "Kentucky Emergency Medical Services Do Not Resuscitate (DNR) Order". Furthermore, the original form should be accessible by EMS when arriving on the scene. If you do not wish for EMS to resuscitate a patient, please download the Kentucky State DNR form and fill it out following the supplied instructions. Without this form, we will have to do everything in our power to keep the patient alive. Keep in mind that this form is only applicable if you stop breathing or your heart stops beating.
It's also important to note that you must present EMS with the original, signed document—not a copy. (We suggest you make several originals so all concerned parties will have an actionable form).
If you need help filling out the form, we will be glad to assist you. Or if you don't have anyway to print out the document, contact us and we will have one sent to your home.
It's also important to note that you must present EMS with the original, signed document—not a copy. (We suggest you make several originals so all concerned parties will have an actionable form).
If you need help filling out the form, we will be glad to assist you. Or if you don't have anyway to print out the document, contact us and we will have one sent to your home.
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Kentucky DNR (English)
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Kentucky DNR (Spanish)
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Kentucky MOST Form
The Medical Order for Scope of Treatment (MOST) form is a voluntary end-of-life planning tool designed to give those who are seriously ill or medically frail the opportunity to make their health care wishes known in the event they are unable to speak for themselves. The MOST form can be completed by a patient or their health care surrogate and must be signed by a doctor.
Additional information can be found at www.kymost.org
Additional information can be found at www.kymost.org