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Maryland Do Not Resuscitate (DNR) Order Form

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The Maryland do not resuscitate (DNR or DNAR) order form is a document in which a patient provides instructions indicating that they would not like to be resuscitated in the event of a cardiac or respiratory arrest. This document may be obtained from the patient’s doctor or upon entry to a hospital. Once completed, the DNR order is filed in the patient’s medical record. If the patient expresses a desire to be resuscitated at any time before entering into cardiac arrest, this action will revoke the DNR order. Furthermore, if an individual signed the order on the patient’s behalf, they can also revoke the order. Although a DNR order on its own is still legal in Maryland, physicians are beginning to use the Maryland Medical Orders for Life-Sustaining Treatment (MOLST) Form, which covers a range of end of life and life-sustaining treatments and guidelines including the DNR order. This document is filled out, signed, and issued by a physician, nurse, or physician assistant and put into the patient’s medical record once completed.

Laws§ 5-608.1

Required to Sign – Physician

How to Write

Step 1 – Download the Maryland MOLST Form (.pdf).

Step 2 – At the top of the page, you will need to provide the patient’s full name, date of birth, and gender.

Step 3 – Beneath “Certification for the basis of these orders,” mark the applicable options in order to indicate under whose authorization you are filling out this form.

Step 4 – Next, select the option for whether the patient should or should not have CPR performed in the event of a cardiac arrest. If the patient wishes to have a DNR order, select the appropriate option(s) to indicate which types of care should be administered before a cardiac arrest might take place.

Step 5 – At the bottom of the page, you must provide your signature, printed name, license number, phone number, and the date.

Step 6 – Enter the patient’s full name, date of birth and gender at the top of the second page.

Step 7 – Mark and fill the appropriate fields to indicate which types of artificial ventilation and blood transfusion shall be permitted.

Step 8 – Next, indicate what the patient’s preferences are regarding hospital transfers, medical workups, and antibiotics.

Step 9 –  Put a mark next to any artificially administered fluids/nutrition and/or types of dialysis that your patient permits for end-of-life care. Below that, write any additional instructions into the “Other Orders” field.

Step 10 – Sign the bottom of the page and provide your printed name, license number, phone number, and the date in the indicated fields.

Step 11  – To make a DNR bracelet for your patient, indicate their DNR Order type at the bottom of the third page. You will also need to supply your patient’s name and date of birth, along with your name, the date, your signature, and your phone number. Once printed, cut off this section and insert it into a bracelet or necklace to give to your patient.


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