CPR and ACLS should not be performed if a valid written "DNR" order is present. In any cases of doubt, paramedics and other medical workers will perform as if a DNR order did not exist, as is required by law.
The exact rules for obtaining and for emergency medical personnel accepting the validity of a DNR order vary widely according to jurisdiction. For example, in the state of Maryland, only Maryland-state DNR orders are acceptable, and they require much verification, witnesses and doctor's signatures in order to be valid. In contrast, the state of West Virginia allows for patients to receive a DNR order with relative ease, and will accept them from most other jurisdictions.
See cardiac arrest
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