Who can request EMS Comfort Care Orders Forms?

The District of Columbia Emergency Medical Services Comfort Care Order is available to physicians and health care facilities such as long term care institutions and hospices. The District of Columbia Department of Health may issue EMS Comfort Care Forms directly for a patient but recommends that forms be obtained by a physician to a patient with whom there is a bona fide physician/patient relationship. It is this physician’s responsibility to discuss the EMS Comfort Care Order with the patient or the person authorized to consent on the patient’s behalf.

How to Request EMS Comfort Care Order Forms? 

All requests for EMS Comfort Care Orders must be submitted to the Health Emergency Preparedness and Response Administration (HEPRA) on an EMS Comfort Care request form or the physician’s or health care facility’s letterhead. A request can be faxed to (202) 671-0707. Requests are generally filled within five business days after receipt of the order.

Voided EMS Comfort Care Orders may be used by facilities for patient education. Original EMS Comfort Care Orders are not to be used for these purposes. Select here for a sample EMS Comfort Care form* to be downloaded from the Health Emergency Preparedness and Response Administration (HEPRA) web site. If you have further questions about ordering EMS Comfort Care Order Forms contact HEPRA at  (202) 671-4222.

A temporary patient bracelet is provided free of charge. An order form for requesting a permanent metal bracelet is enclosed in the EMS Comfort Care Order Kit.

Please contact the DNR Program at (202) 671-4222 or select EMS Comfort Care* to request EMS Comfort Care Orders or a sample EMS Comfort Care Order.



 
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