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Home Personal & Family Documents DNR Form

Free Do Not Resuscitate (DNR) Form

Use our DNR Form if you don’t want cardiopulmonary resuscitation (CPR) if your heart stops, or you stop breathing.

Updated January 18, 2023 | Legally reviewed by Susan Chai, Esq.

A do not resuscitate order, or DNR form is used by people who do not want to be revived if their heart stops. This means if you have a completed and signed DNR form, medical professionals will not save your life if you go into cardiac arrest or stop breathing.

DNR forms usually must be signed by your doctor, witnesses, and a notary public. In addition, you should familiarize yourself with your state’s do not resuscitate laws before you complete your form.

Table of Contents
  • What is a DNR Form?
  • When is a DNR Form Appropriate?
  • Free DNR Form Sample (PDF & Word)
  • How to Get a DNR Form
  • Laws and Signing Requirements - by State

What is a DNR Form?

A Do Not Resuscitate Form, or DNR Form is an end-of-life medical directive that instructs health care professionals to withhold life-sustaining treatment at the behest of the patient.

Patients who choose to obtain this type of document order are assured that no resuscitation methods will be performed in the event of a medical emergency — it’s important to understand what a DNR is before signing.

A DNR form is a specific document governing distinct forms of treatment and as a result, there are essentially no differences between the multiple types of a written order.

DNR forms may be known by the following names, depending on your location:

    • DNAR (Do Not Attempt Resuscitation)
    • AND (Allow Natural Death)
  • POLST (Physician Orders for Life-Sustaining Treatment)
  • MOLST (Medical Orders for Life-Sustaining Treatment)

In addition to a DNR form, the following are important estate and end-of-life planning documents:

  • Last Will and Testament
  • Medical Power of Attorney
  • Living Will

What Does DNR Mean?

DNR simply stands for “do not resuscitate”. If your heart stops beating or you stop breathing, a DNR order restricts emergency medical technicians or hospital personnel from attempting to revive you.

What Does Resuscitate Mean?

In medical terms, “resuscitate” simply refers to the various procedures used by healthcare professionals in an emergency situation 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.

Basic CPR techniques involve a series of chest compressions and occasional mouth-to-mouth breathing.

Advanced cardiopulmonary resuscitation (typically performed by EMS responders or trained medical personnel) involves a device known as a defibrillator or AED. An AED delivers an electrical shock to the patient in order to reestablish a steady rhythm to their heartbeat.

As a reference, resuscitation methods may include:

  • Cardiac compression (or chest compressions)
  • Defibrillation (electrical shock)
  • Artificial ventilation (mouth-to-mouth breathing)
  • Intubation (advanced airway management involving a breathing tube)

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

When is a DNR Form Appropriate?

End-of-life planning can be a difficult subject to address, let alone navigate. But the fact of the matter is, we all must deal with this issue at some stage of our lives. Obtaining your own DNR document should not be taken lightly — as it truly addresses life and death matters.

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

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

Scenario #2: Elderly Individuals

Age is another factor that’s important to keep in mind when debating whether a DNR form is right for you. Resuscitation is an intense and oftentimes traumatic medical procedure that elderly patients may have trouble recovering from should it be successful.

Chest compressions must be applied with extreme force in order to get the blood pumping through the heart. Broken ribs, bruised lungs, or even damage to the heart itself are all potential ramifications of successful CPR.

Intubation may also be used if a patient stops breathing. This invasive technique requires a tube to be rapidly inserted into the windpipe of a patient in order to manage airflow. This can lead to minor or severe complications such as damage to the esophagus and other tissue in the throat.

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. With that said, each patient must consider their own personal ethics and religious values before authorizing any end-of-life planning documentation.

What Happens if a DNR is Not Followed?

In 2016, a woman in Santa Fe, New Mexico was admitted to the emergency room of a local hospital. Hospital staff attempted to resuscitate her twice — in direct violation of her do not resuscitate order. [1]

This particular patient suffers from a rare condition that causes her immense pain and requires costly medication. As a result of this condition, she preemptively drafted a form in order to avoid further expense and suffering. The hospital staff ignored the order, and she filed a lawsuit shortly after the ordeal.

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

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

Free DNR Form Sample (PDF & Word)

You can use our free DNR template as an example for creating your own:

This Do Not Resuscitate form has been updated for 2023.

Download PDF
Download Word Doc

How to Get a DNR Form

Once you’ve decided to create your own document, there are plenty of ways to get a DNR form.

Our DNR form builder handles all of the necessary paperwork for you. Upon completion, take your DNR medical form to your physician and have them sign it. Your doctor should then file it with the rest of your medical records.

In some instances, EMTs arriving on the scene of a medical emergency 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 be on your person at all times — instructing first responders on how to proceed.

Laws and Signing Requirements – by State

Nearly every state in America has guidelines governing do not resuscitate orders. These laws ensure patients retain a sense of control over their end-of-life planning.

The following table shows which states require signatures from patients, physicians, witnesses, a notary public, or some combination of each, in order for a DNR form 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

Who signs the DNR form?

The DNR order must be signed by the patient or by the patient’s legally appointed health care professionals that must make medical decisions on the patient’s behalf. All parties who have signed the form must sign twice, once more at the bottom of the page to confirm proper completion.

In the table above you also have the signing requirements for each state.

Legal Templates uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial guidelines to learn more about how we keep our content accurate, reliable and trustworthy.

  1. Woman sues hospital for resuscitating her. https://www.abqjournal.com/1247179/woman-sues-hospital-for-resuscitating-her-ex-patient-alleges-her-dnr-directive-was-ignored-after-drug-allergy-caused-her-to-have-a-cardiac-arrest-2.html

Related Health & Medical Documents

  • Advance Directive: Declare your health care wishes if you’re incapacitated and can’t make your own decisions.
  • Living Will (Health Care Directive): Define your healthcare treatment and end-of-life decisions.
  • Medical Power of Attorney: A Medical Power of Attorney allows you to name a health care agent to make health decisions for you if you cannot.
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Free Do Not Resuscitate (DNR) Form

Create your Do Not Resuscitate Order in Minutes.

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Free Do Not Resuscitate (DNR) Form

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