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Free DNR Order Form

Use our Do-Not-Resuscitate order template to list treatments you want to be withheld if you don’t want life-saving intervention. Outline your health preferences and decisions in your DNR form.

Last Update August 9th, 2022

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What is a Do-Not-Resuscitate Order

A Do-Not-Resuscitate order or DNR order is a legal document that is used by patients who are terminally ill. 

It is fairly common among people who have an illness or condition that cannot be cured and will almost certainly lead to death. It is also common among elderly people.  

The purpose of a DNR order is to request not to be brought back to life by any means, for example, by CPR. 

Although it’s usually the same throughout the country, some states have specific requirements for this document.

When to Use a DNR Form

A DNR form is something you have to plan in advance. 

However, you may be wondering, at what moment does someone need it? 

There are situations when someone requires aggressive treatment to continue living. Especially those who are terminally ill. 

Depending on your personal preferences and circumstances, you might feel that it’s better to simply pass on peacefully. 

For instance, you may not want to be brought back to life when: 

  • There is no benefit to your health: CPR, for instance, is not intended for people who are terminally ill. The treatment most likely wouldn’t be successful. 

  • A loss of quality of life: The life-saving measures may save you. However, there is a good chance you survive with severe harm to your organs. This means you would be dependent on a machine to breathe and stay alive. 

  • Already close to death: Instead of a forceful intervention, a peaceful death might seem like the better option. 

How to Get a DNR Form

If you feel that it would be a good idea to create your own Do-Not-Resuscitate order, then you have to follow some steps. 

At first, you might not be sure how to obtain a DNR form. 

LawDistrict makes it a much easier process thanks to our printable documents and guidance

Once you have your form, follow these steps to formalize your order. 

  1. Speak with your (or a)physician: For a DNR form to be activated, it requires a doctor’s signature. The doctor confirms that you as the patient are sane enough to come to this decision. The doctor confirms you are signing the document voluntarily. 

  2. Choose possible medical treatments: The main treatment a DNR form covers is CPR treatment. You have the right to accept or refuse other treatments, such as chemo or breathing machines. You can finalize these requests in a Living Will

  3. Get formed signed: Different states have different requirements. However, in general, you will need to sign the DNR order in front of two witnesses and a doctor. 

  4. Receive DNR Bracelet: Patients that choose to complete a DNR form often get a bracelet or other type of accessory. This notifies doctors to follow DNR requests.

How to Write a DNR Form

There are very important details and information that must be included in a DNR form. 

Follow these steps to know exactly what you need to write on the document. 

  1. Write the name of the patient and then state where you or that person lives. 

  2. Make sure to make the requests known, that CPR, or another treatment, is to be withheld. 

  3. Acknowledgement: The people who are in charge of the patient must sign the document. Signing means they acknowledge and support the preferences. 

  4. Attorney-in-fact Consent: Choose an Attorney-in-Fact.

  5. Surrogate Consent: The Health Care Surrogate directs treatment based on what the patient would have wanted. He or she must sign. 

  6. Authorization from a Medical Doctor: A physician signs this part. It directs any medical personnel to stop treatments that could save the patient’s life.  

  7. Witnesses and/or Notary Public: Declare that everyone signing the document is of sound mind. Then they must also sign. 

NDR Laws and Requirements by State

As with many legal documents, NDR forms have different requirements to meet according to their state. 

Have a look at the table and see what your state signing requirements are. 

State Signing Requirements Law
Alabama Patient and Medical Doctor § 420-5-19-.02
Alaska Patient and Medical Doctor § AS 13.52.150
Arizona Patient, Medical Doctor, and Witness § 36-3251
Arkansas Patient and Medical Doctor § 20-13
California Patient and Medical Doctor § 4780
Colorado Patient and Medical Doctor § 15-18.6-102
Connecticut Patient and Medical Doctor § 19a-580d
Delaware Patient and Medical Doctor § 2509A
Florida Patient and Medical Doctor § 64J-2.018
Georgia Medical Doctor § 31-39-(2-9)
Hawaii Patient and Medical Doctor § 327K-2
Idaho Patient and Medical Doctor § 39-4514
Illinois Patient, Medical Doctor, and Witness § 755 ILCS 40/65
Indiana Patient, Medical Doctor, and two Witnesses § 16-36-5
Iowa Medical Doctor § 144A.7A
Kansas Patient, Medical Doctor, and Witness § 65-4943
Kentucky Patient, and two Witnesses or Notary Public § 311.623
Louisiana Patient and Medical Doctor § 40:1155.3
Maine Patient and Medical Doctor § 93-A.1(b)
Maryland Medical Doctor § 5-608.1
Massachusetts Patient and Medical Doctor None
Michigan Patient, Medical Doctor and two Witnesses § 333.1053
Minnesota Patient and Medical Doctor § Chapter 145C
Mississippi Patient and Medical Doctor § 41-41-302
Missouri Patient and Medical Doctor § 190.603
Montana Patient and Medical Doctor § 37:10
Nebraska Patient, M.D. and Witness/ Patient and Two Witnesses for Declaration § 20-404
Nevada Patient and Medical Doctor § 450B.520
New Hampshire Patient and Medical Doctor § 137-J:26
New Jersey Patient and Medical Doctor N.J.A.C. 10:48B
New Mexico Patient and Medical Doctor § 7.27.6.8
New York Patient and Medical Doctor § Senate Bill S7883
North Carolina Patient, Two Witnesses and Notary Public for Declaration § 90-321 & § 90-322
North Dakota Patient and Medical Doctor for POLST § 23-06.5
Ohio Medical Doctor § 3701-62
Oklahoma Patient, Medical Doctor, and Two Witnesses § 63-3131.5
Oregon Medical Doctor for POLST § 847-035-0030(6) & § 847-010-0110
Pennsylvania Patient and Medical Doctor § 5481 – § 5488
Rhode Island Patient and Medical Doctor § R23-4.11-MOLST
South Carolina Patient and Medical Doctor § 44-78-10 – § 44-78-65
South Dakota Patient and Medical Doctor § ARSD 44:05:06 & SDCL 34-12F
Tennessee Patient and Medical Doctor for POST § 68-11-224
Texas Patient, Medical Doctor and either Two Witnesses or 2nd M.D. § 157.25 & Chapter 166
Utah Patient and Medical Doctor § R432-31
Vermont Patient and Medical Doctor § 9708 & § 9709
Virginia Patient and Medical Doctor § 54.1-2987.1
Washington Patient and Medical Doctor for POLST § 43.70.480 & § 70.245
West Virginia Patient and Medical Doctor for POLST § 16-30C
Wisconsin Patient and Medical Doctor § 154.17 – § 154.29
Wyoming Patient and Medical Doctor § 35-22-501 – 35-22-509

DNR Sample Form

Even if you have all the information available to make your DNR order form, it is a good idea to have a look at a sample before you make your own.  LawDistrict provides a printable DNR form for you to see and use as a template.

FAQs About DNR Forms

If you are still left with doubts about Do-Not-Resuscitate orders, we can clear those up for you. 

Below, the most common questions regarding DNR orders are answered. 

How to Revoke a Do-Not-Resuscitate Order

Firstly, if you ever would like to revoke your DNR order, you should speak with your physician. 

Secondly, you then should eliminate any DNR documents and accessories, such as the DNR bracelet.  

These could be found by medical staff, and they might continue with the DNR order. 

Who Needs a DNR Form?

There are very specific people who might want a DNR form. For example, people who have been suffering from an illness for a very long time. 

The list of people who would choose a DNR order are usually suffering from

  • Long-term illness;

  • Terminal illness;

  • Alzheimer’s Disease; 

  • Dementia

People who are extremely elderly are also those who choose to have a DNR order. 

Living Will vs DNR

A Living Will may seem almost the same as a DNR order

The difference between the 2 is a Living Will restricts a patient’s access to nourishment,  food and water, or a breathing machine. 

A DNR order restricts immediate intervention, such as CPR, to save someone’s life. 

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