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Michigan Do Not Resuscitate (DNR) Order Form

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A Michigan do not resuscitate (DNR or DNAR) order form is a document which is issued by an individual in order to alert medical staff that, in the event of a cardiac arrest, they do not want to be resuscitated by CPR or other means. In Michigan, a DNR Order can be issued either in consultation with a physician or for religious reasons. In both cases, the subject will need to obtain the signatures of two (2) witnesses in order for the document to be accepted. Once the DNR Order is filled out, it must be given to the subject’s physician to be included in their medical record. A DNR Order will often be printed on brightly colored paper so that it stands out when the subject’s medical record is consulted.

Laws – § 333.1051 to 333.1067

Required to Sign – Patient (or representative), physician, and two (2) witnesses.

How to Write

Step 1 – Download the document in Adobe PDF.

Step 2 – For a standard DNR Order, on Page Three (3), the subject should enter the name of their physician and provide their signature and printed name as well as that of their physician, along with the date. If someone signed on behalf of the patient, they must also supply their name, signature, and the date.

Step 3 – Obtain the signatures of two (2) witnesses and print their names below each one.

Step 4 – Individuals who wish to issue a DNR Order for religious reasons should fill out Page Four (4) of the document by providing their signature (or signature of their representative), printed name, and the date.

Step 5 – Two (2) witnesses must also sign and date the document. Once the DNR Order has been completed, it must be given to the subject’s physician to be included in their medical record.


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