Advance Directives and Medical Orders

Comfort OneAdvance directives and medical orders are forms and authorizations that allow you to direct physicians to withhold or withdraw life-sustaining treatment. They allow you to tell doctors and those close to you what you wish to be done should you need life-sustaining treatment. If you don’t have an advance directive, doctors may use machines, such as respirators, to keep you alive.


Comfort One in South Dakota provides quick identification of patients who choose not to receive life-prolonging treatment (chest compressions, breathing tubes, shock, etc.) by emergency personnel. Patients wear a special bracelet or have a document that states these requests and that the emergency team should only provide comfort measures. The Comfort One form must be signed by your physician, nurse practitioner, or physician assistant.

SDCL 34-12F Cardiopulmonary Resuscitation Directive
Defines terms and criteria for DNR directives.

ARSD 44:05:06 EMS Cardiopulmonary Resuscitation Directives Defines terms and criteria for EMS personnel.

Physicians and medical centers can request Comfort One forms by calling 605-773-4031 or emailing

Completed forms should be sent to: South Dakota Department of Health, 600 E. Capitol, Pierre, SD 57501.

Individuals wishing to register for Comfort One should request the form from their healthcare provider.

Comfort One Bracelet

The Comfort One bracelet costs $44.70, is optional, and can be used for identification in place of the Comfort One form. This is a great option for those away from home as an alternative to carrying the Comfort One EMS Cardiopulmonary Resuscitation Directive.

A fully completed Comfort One form must be submitted to obtain the bracelet.  This form must be completed with assistance from your medical professional and must be signed by both the patient or personal representative and the medical professional.  The information will be placed in the Comfort One database maintained by the South Dakota Department of Health and will include the bracelet number should that option be selected.

The bracelet is a brass base with gold plating and the charm logo is bronze with gold plating. The gold plating is non-magnetic and is hypoallergenic. The bracelet is approximately 8” long, and links may be removed as needed by a jeweler.

Mail the completed Comfort One application and your check or money order for $44.70 to: Office of Rural Health/EMS South Dakota Department of Health 600 East Capitol Ave. Pierre, SD 57501

Please make checks payable to the Office of Rural Health – EMS.

Questions? Please call (605) 773-3361

Medical Orders for Scope of Treatment (MOST)

MOST is a medical provider's order that outlines a plan of care respecting the patient's wishes concerning care at the end of life. MOST is not a legal document. It is a transportable medical order signed by a healthcare provider for individuals with a terminal illness. The goal of the MOST initiative is to inform and empower patients to clearly state their end-of-life care wishes, and to authorize healthcare providers to carry out those wishes.

MOST is only for patients with a terminal illness as defined by SD Law § 34-12D-1.

South Dakota Senate Bill 118 to establish certain provisions regarding advance care planning, was signed by the governor on March 27, 2019.