» Do Not Resuscitate (DNR) Order Forms

Do Not Resuscitate (DNR) Order Forms

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Do not resuscitate order (DNRO) forms are created for patients that do not want to be saved in the event their heart or breathing stops. This is generally the case for individuals with late stages of cancer or other advanced medical issues. The laws for withholding resuscitation are governed by each State and usually comes with the requirement that the patient authorizes the form along with their primary care physician, notary public, or witness(es).

Signing Requirements – Must be authorized by the patient in accordance with State law.


Advance Directive (Living Will) – Allows for a patient to create a do not resuscitate (DNRO), choose their end of life decisions, and health power of attorney all in 1-document (sometimes referred to as an “Advance Directive”).

By State

Table of Contents

What is a Do Not Resuscitate Order?

A do not resuscitate order, also referred to as a “DNRO”, is for individuals that are terminally ill and do not want to be brought back to life via CPR, defibrillation, or other related options. This is common when a person is elderly or suffering from a health condition where there is no foreseeable path to a cured condition. To create a do not resuscitate order, in most States, the patient will need to have the form signed between themselves, their physician, and witnesses (if required).

How to Get a Do Not Resuscitate Order

Step 1 – Speak with a Physician

A Do-Not-Resuscitate Order (DNRO) is a medical directive to doctors and other first responders instructing them to withhold CPR treatment should a patient’s breathing or heart stop. Also called a “no code” or “allow natural death” order, the DNRO is completed in conjunction with a physician, whose signature is required to implement it. The form may be completed in the hospital or elsewhere, but should be filed with other medical records so that all caregivers are made aware of this intention.

Since filing a DNRO is literally a matter of life and death, the document affirms that the patient is of “sound mind” – that the decision to refuse CPR has been made by the patient voluntarily and with a clear understanding of its implications.

Step 2 – Decide on Future Medical Treatment

Contrary to common misconception, the DNRO is not a blanket declaration covering all medical interventions. It relates only to cardiopulmonary resuscitation. Other modes of treatment, including the provision of drugs and chemotherapy, testing, and the vast array of supports in the modern medical arsenal are generally excluded.

A DNRO should be part of a more comprehensive plan for medical care. Patients generally have the right to choose which treatments to accept and should be at the wheel in steering their own treatment process – but things can get more complicated if the patient is incapacitated or is otherwise unable to communicate with medical staff or family members. The best course is to formalize these more comprehensive care directives in a “living will” or “advanced directive.” See below for more information.

Step 3 – Download, Complete, and Sign

The Do-Not-Resuscitate form should be printed and signed by hand by both doctor and patient in the presence of two witnesses. These witnesses serve to validate the signatures of the doctor and patient – but also to verify that the patient was of sound mind and acting voluntarily when the document was signed (View State Signing Requirements)

Both patient and doctor should retain copies of the DNRO.

Step 4 – Store the Form in a Safe Place

While a DNRO should ensure that a patient is not given CPR in a hospital setting, it may not alter the course of treatment at home. To help ensure that the Do-Not-Resuscitate intention is conveyed, patients are often given a bracelet or other identifying article that would be visible to first responders and others in an emergency, non-hospital settings.

Reasons to Have a Do Not Resuscitate Order

While modern medicine continues its impressive advance, patients still find themselves in difficult, even terminal situations. Those who opt for DNRO’s have often been suffering from the following:

  • Long-term illness;
  • Prolonged pain;
  • Elderly;
  • Terminally ill;
  • Dementia; or
  • Alzheimer’s Disease.

Living Will vs Do Not Resuscitate Order

living will restrict a patient’s right to food, water, and assisted breathing in a terminally ill state and a do not resuscitate order restricts a patent’s right to immediate life-saving methods such as CPR.

How to Revoke a Do Not Resuscitate Order

To revoke a DNRO, speak with your doctor. In addition, you should destroy any documentation that asserts the DNRO, including bracelets, wallet cards, or other indicators that might be found by emergency personnel.

State Laws and Signing Requirements

A do not resuscitate order is required to be authorized in accordance with State law.

State

Signing Requirements

Laws

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

How to Write a Do Not Resuscitate Order

Download: Adobe PDF, Microsoft Word (.docx) or Open Document Text (.odt)

1 – The DNR Form On This Page Can Be Easily Accessed and Downloaded

This declaration is available as a PDF document or in one of the word processing formats presented above. It is recommended that you choose a file version that you can edit with your current software. If preferred, you may also use your browser to open then print this form, then complete it manually.

2 – Produce The Full Name Of Both Physician And Declarant

This form will require the full name of the Patient’s Doctor recorded on the first space after the words “My Physician, Dr.” In addition, the name of the individual who does not wish to be resuscitated must be furnished to the blank space attached to the bracketed label “Patient’s Name.”

3 – A Witnessed Signature Is Required For This Form

Both the Patient and his or her Physician will have to sign this document for this declaration to be taken seriously. Additionally, these signatures must be physically observed by two qualified Witnesses. Once these parties meet for the signing, the Patient should sign his or her name on the blank space labeled “Declarant’s Signature” then produce the current “Date” on the adjacent blank space. The Patient’s Doctor must sign his or her name on the “Physician’s Signature” line then document his or her signature date on the space labeled “Date.” Once both parties have furnished their dated signatures, this document should be turned over to the Witnesses who have watched the signing occur. Each one should read the “Attestation Of Witnesses” statement then, sign and print his or her name.  Each signature supplied by a Witness should be dated by the Witness at the time of signing on the line labeled “Date.” 


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