Do Not Resuscitate (DNR) Form

Use our DNR order if you don’t want cardiopulmonary resuscitation (CPR) when your heart stops.

do not resuscitate (dnr) form

Updated January 31, 2024
Written by Ioana Gagiuc | Reviewed by Brooke Davis

A do not resuscitate (DNR) order is used by individuals who do not want to be revived if their heart or breathing stops. It restricts emergency medical technicians or hospital personnel from attempting to save your life if you go into cardiac arrest or another life-threatening emergency.

Signing Requirements

DNR orders typically must be signed by your doctor, witnesses, and/or a notary public. You should familiarize yourself with your state’s do not resuscitate laws and signing requirements before you complete your form.

What Is a DNR Form?

A DNR form is an end-of-life medical directive instructing healthcare professionals to withhold life-sustaining treatment at the patient’s request. It is used to prevent inappropriate administration of CPR, while all other treatments aimed at ensuring the individual’s comfort and pain relief will continue uninterrupted.

The laws regarding the withholding of resuscitation vary by state and typically mandate that the patient, along with their primary care physician, notary public, or witnesses, provide their signature on this form.

This protocol is frequently implemented in cases involving elderly individuals or those afflicted with conditions where a complete cure is not anticipated.

Do not resuscitate orders may be known by the following names, depending on your location:

What Does Resuscitate Mean?

In medical terms, “resuscitate” refers to the various procedures used by professionals in an emergency to revive a person from unconsciousness or the brink of death. In the case of a DNR order, however, “resuscitate” specifically refers to the use of cardiopulmonary resuscitation — commonly referred to as CPR.

As a reference, resuscitation methods may include:

A do not resuscitate form instructs physicians not to use any form of CPR (basic or advanced) should they become incapacitated and require a life-sustaining procedure.

When Is a DNR Form Appropriate?

A DNR order is put into effect when a person has a background of chronic disease or terminal illness, which has previously or might in the future require CPR, and that patient, due to concerns regarding the potential failure of CPR and the risk of sustaining brain damage or impairment, expresses their wish not to be resuscitated.

Scenario #1: Patients / Individuals Diagnosed with a Terminal Condition

For anyone diagnosed with a painful or terminal condition, DNR orders can help avoid prolonged suffering. Choosing to withdraw resuscitation in the event of a cardiac or respiratory arrest does not mean palliative care will be withheld. That is to say, administering pain-relieving medication and comfort care will still be offered, should you desire.

Scenario #2: Elderly Individuals

Another essential factor to remember is the age when debating whether a DNR form suits you. Resuscitation is an intense and often traumatic medical procedure that elderly individuals may have trouble recovering from should it be successful.

Scenario #3: Religious Values

Contrary to what some may think, signing a do not resuscitate order is not prohibited in the eyes of many religious institutions. Patients should consider their ethics and religious values before authorizing any end-of-life planning documentation.

What Happens if a DNR Is Not Followed?

Failing to follow a DNR order may lead to unwanted medical interventions that contradict the patient’s wishes, as expressed in the document. Healthcare providers and institutions may face legal repercussions for disregarding a valid order. This could result in medical malpractice claims, civil lawsuits, or disciplinary action.

Signing a DNR order is the same as any other legally binding document. Once your DNR documents have been approved and filed into your medical records, they must be recognized and followed by any physician who treats you.

Additionally, your family can’t override your form against your will. Unless you have authorized someone to act on your behalf as your healthcare representative (either within the document itself or through a medical power of attorney), only you may choose to revoke your DNR order.

DNR vs Living Will

When it comes to end-of-life care, two important legal documents that allow individuals to express their preferences for such situations are the DNR order and the living will. While both serve similar purposes, there are differences in their scope and execution:

In addition to DNR orders, further vital estate and end-of-life planning documents are crucial for ensuring individuals’ wishes are upheld, and their affairs are managed according to their preferences:

How to Get a DNR Form

Once you’ve decided to create your document, there are plenty of ways to obtain a DNR order form:

Speak With Your Physician

The DNR is completed in collaboration with a physician. They will assess your medical condition and explain the potential benefits of having a DNR order in place, helping you make an informed decision.

While the form can be filled out either within the hospital premises or elsewhere, it should be filed with other medical documents to ensure that all caregivers are informed of the patient’s intentions.

Given that filing a DNR holds critical implications for life and death, the document verifies the patient’s mental capacity, confirming that the choice to decline CPR has been made voluntarily, with a clear understanding of its consequences.

Obtain Your DNR Bracelet

Secure your DNR bracelet to ensure your medical preferences are honored, particularly during emergencies. There may be instances where Emergency Medical Technicians (EMTs) responding to a crisis may not immediately be able to identify you or have access to your medical records on hand.

Ask your doctor where you can find an official DNR bracelet that can always be on your person — instructing first responders on how to proceed and enabling them to respect your medical decisions and provide care aligned with your wishes.

Use a DNR Form Builder

Once you’ve completed the form, take it to your physician for their signature. They will then ensure it is properly filed alongside your other medical records.

This way, you can simplify the paperwork involved in documenting your end-of-life preferences, ensuring that your wishes regarding resuscitation are readily accessible to healthcare providers when needed.

How to Write a Do Not Resuscitate Order

Here are some key steps to follow when writing a do not resuscitate (DNR) order:

Step 1 – Complete the DNR Form

The document may vary depending on your location, but it will typically require you to specify your preferences regarding CPR and any additional instructions. Fill in your name and the state where you live.

Step 2 – Sign and Date the Document

Once the DNR form is filled out, ensure it is signed and dated by both you (or your legally authorized decision-maker, if applicable) and your healthcare provider. In some instances, either a witness or a notary is required to sign the document for it to obtain legal power.

Step 3 – Distribute and Inform

Make sure that copies of the signed form are distributed to relevant healthcare facilities and notify anyone involved in your medical care about the existence of the DNR.

Step 4 – Regularly Review and Update

Over time, your medical condition and preferences may change. It’s essential to review your DNR order periodically and, if necessary, make updates or revisions to ensure it accurately reflects your current wishes for end-of-life care.

Can a DNR Be Revoked?

Yes, a DNR order can typically be revoked or modified by the patient or their decision-maker at any time if their medical condition or preferences change. Here are some steps to follow:

Laws and Signing Requirements – by State

The following table shows which states require signatures from patients, physicians, witnesses, a notary public, or some combination of each for a do not resuscitate order to be legally valid:

State Who Needs to Sign? Legal Code
Alabama Patient and Physician AL Code § 420-5-19-.02
Alaska Patient and either a Witness, Notary Public, or Physician AK Stat 13.52.150
Arizona Patient, Physician, and Witness AZ Rev Stat § 36-3251
Arkansas Patient and either a Notary Public or 2 Witnesses AR Code § 20-13-901
California Patient and Primary Physician CA Prob Code § 4780
Colorado Patient and Attending Physician CO Rev Stat § 15-18.6-103
Connecticut Patient and Physician CT Gen Stat § 19a-580d
Delaware Patient and 2 Witnesses 16 DE Code § 2505
Florida Patient and Primary Physician FL Stat § 401.45
Georgia Patient and Attending Physician GA Code § 31-39.6.1
Hawaii Patient and Attending Physician HI Rev Stat § 327K-2
Idaho Patient and Physician ID Code § 39-4514
Illinois Patient and Witness 755 ILCS 40/65
Indiana Patient, Physician, and 2 Witnesses IN Code § 16-36-5
Iowa Physician IA Code § 144A.7A
Kansas Patient and Witness KS Stat § 65-4943
Kentucky Patient and Primary Physician KY Rev Stat § 311.6225
Louisiana Patient and 2 Witnesses LA Rev Stat § 40:1151.2
Maine Patient and 2 Witnesses ME Rev Stat § 5-805
Maryland Patient and Physician MD Health-Gen Code § 5-608.1
Massachusetts Patient and Physician None
Michigan Patient, Attending Physician, and 2 Witnesses MI Comp Laws § 333.1053
Minnesota Patient and either a Notary Public or 2 Witnesses MN Stat Chapter 145C
Mississippi Patient and Physician MS Code § 41-41-302
Missouri Patient and Attending Physician MO Rev Stat § 190.600
Montana Patient and 2 Witnesses MT Code § 50-9-103
Nebraska Patient and either a Notary Public or 2 Witnesses NE Code § 20-404
Nevada Patient and Attending Physician NV Rev Stat § 450B.520
New Hampshire Patient and Attending Physician NH Rev Stat § 137-J:26
New Jersey Patient and Attending Physician NJ Admin Code § 10:48B
New Mexico Patient and Physician NM Stat § 7.27.6.8
New York Patient and Physician NY Public Health Article 29-B
North Carolina Patient, a Notary Public, and 2 Witnesses NC Gen Stat § 90-321
North Dakota Patient and either a Notary Public or 2 Witnesses ND Cent Code § 23-06.5
Ohio Patient and Physician OH Admin Code § 3701-62
Oklahoma Patient, Physician, and 2 Witnesses OK Stat § 63-3131.5
Oregon Patient and 2 Witnesses OR Rev Stat § 127.810
Pennsylvania Patient and Attending Physician PA Con Stat Title 20 § 5484
Rhode Island Patient and 2 Witnesses RI Gen Laws § 23-4.11
South Carolina Patient and Physician SC Code § 44-78-10
South Dakota Patient and Attending Physician SD Admin Rules § 44:05:06
Tennessee Patient and Physician TN Code § 68-11-224
Texas Patient and either a Notary Public or 2 Witnesses TX HSC Chapter 166
Utah Patient and Physician UT Admin Code § R432-31
Vermont Patient and Physician VT Stat Title 18 Chapter 231
Virginia Patient and Physician VA Code § 54.1-2987.1
Washington Patient and 2 Witnesses WA Rev Code § 70.245
West Virginia Patient and Physician WV Code § 16-30
Wisconsin Patient and Physician WI Stat § 154.17
Wyoming Patient and Physician WY Stat § 35-22-501
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DNR Form Sample

You can download our free do not resuscitate (DNR) order template below as an example for creating your own.

do not resuscitate (dnr) form

do not resuscitate (dnr) form

Create a Do Not Resuscitate (DNR) Order Here!