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Maine Do Not Resuscitate (DNR) Order Form

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The Maine do not resuscitate (DNR or DNAR) order form is a document which doctors provide to patients who do not want to be resuscitated in the event that their breathing or heartbeat stops. Once the patient has filled out the document and both they and the doctor have signed the order, it will be added to their medical record. Such an order may also be requested when a patient is admitted to a hospital. A DNR Order must be honored by all medical personnel and exempts said personnel from any litigation for not administering life-saving procedures.

Laws§ 93-A.1 (b)

Required to Sign – The patient and physician must both sign.

How to Write

Step 1 – Download the DNR Order in Adobe PDF.

Step 2 – Enter your name in the blank space at the top of the page in the paragraph which affirms that you have discussed this DNR Order with your physician.

Step 3 – Next, check the appropriate box to indicate whether or not this DNR Order will have an expiration date. If it will expire, write the expiry date in the indicated field. Below that, provide your signature and the date.

Step 4 – At the bottom of the page, the physician must provide their signature, license level, the date, their printed name, and their telephone number.


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