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Kansas Do Not Resuscitate (DNR) Order Form

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The Kansas do not resuscitate (DNR) order form is a document stating a person’s decision not to have any resuscitative procedures administered by medical personnel should their heart or breathing stop. Although a patient who requests a DNR will not be given CPR or other such procedures, they may be provided non-resuscitative comfort-related medical care. A DNR form is a type of advance directive, meaning it is an order completed before a medical emergency occurs so that EMTs, paramedics and other health professionals are aware of what type of procedures they are able to perform on a patient. Typically, DNRs are reserved for patients who are suffering from a terminal illness or a condition that would render CPR useless or fatal. In order for a DNR form to be valid, the patient’s physician must endorse the decision and sign the form. However, in cases where the patient is a member of a church that provides treatment by spiritual means, a physician’s signature is not required.

Laws§ 65-4941 through § 65-4948

Required to Sign – Patient, physician and a witness.

How to Write

Step 1 – Download the DNR form in Adobe PDF.

Step 2 – On the first line of the form, enter the patient’s name.

Step 3 – The patient and witness must sign and date the form on the appropriate lines.

Step 4 – The attending physician must provide their signature, the date, their address and facility name in the applicable fields.


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