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Georgia Do Not Resuscitate (DNR) Order Form

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The Georgia do not resuscitate (DNR) order form is a document requested by an individual (patient) who does not wish to have any resuscitation procedures performed on them in the event of cardiac or respiratory arrest. This form is reserved for patients who have a medical condition which, upon the use of CPR or other resuscitation procedures, would result in imminent death. Furthermore, patients who are in a noncognitive state with no reasonable possibility of regaining said cognitive functions and patients for whom CPR would be futile would also be appropriate candidates for a DNR. In the event that a patient is unable to make decisions for themselves (e.g., incompetent or in a noncognitive state), an authorized representative can make a DNR request on their behalf. In all cases, the patient’s physician will be the one to complete and sign the DNR form. Individuals who are no longer hospitalized, but wish to wear a DNR identifier (bracelet), can ask their physician to complete this request for them (see instructions below)

Laws§ 31-39-(2-9)

Required to Sign – Physician.

How to Write – DNR Order

Step 1 – One can ask the patient’s physician to draft a DNR form on behalf of the patient. Otherwise, download the sample Georgia DNR form in Adobe PDF.

Step 2 – Provide the following information in the applicable fields:

  • Patient’s name
  • Physician signature
  • Name of physician
  • Physician’s phone number
  • Date of signing

How to Write – DNR Bracelet (Optional)

Step 1 – Download the DNR Bracelet Request Form in Adobe PDF.

Step 2 – Enter the following information onto the appropriate lines:

  • Patient’s name
  • Authorized person’s name and phone number (if applicable)
  • Physician’s name and phone number
  • Date of order


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