A Do Not Resuscitate (DNR) order is a specific medical instruction informing healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops beating or you stop breathing. This directive is a medical order, not simply a legal preference, and it strictly applies only to withholding CPR, which includes chest compressions, artificial ventilation, and defibrillation. To be recognized, a DNR form must be executed precisely according to the laws of the state where the patient is located, as these rules are highly state-specific. This medical order is distinct from a Living Will or a Healthcare Power of Attorney, which are broader advance directives that cover a wider range of life-sustaining treatments and appoint a decision-maker.
Locating the Official DNR Form
The most reliable source for the official DNR paperwork is often the patient’s treating physician or the healthcare facility where the patient is receiving care. A physician’s office is best equipped to provide the specific form required for use in both hospital and out-of-hospital settings within that state. Since the form must be signed by a physician to be valid, beginning the conversation with a doctor is a practical first step.
Many state governments also provide downloadable versions of the current, state-approved DNR form directly on their websites, typically under the Department of Health or Emergency Medical Services (EMS) division. These forms are designed to meet the strict legal requirements for emergency personnel and are often specific in their color or format to ensure immediate recognition. In some instances, specialized organizations, such as the state medical association, may be the designated distributor of the official pre-hospital form.
For individuals who require more specialized assistance, certified legal aid services or an elder law attorney can help procure the correct document. Some states may also require the form to be filed with a specific state registry after execution, which adds another layer of validation for healthcare providers.
Procedural Requirements for Legal Validity
Once the correct, state-specific form is obtained, it must be validated through a specific set of signatures to become a legally binding medical order. The most fundamental requirement is the signature of the patient or the patient’s legally recognized healthcare decision-maker, confirming informed consent to the DNR instruction. Equally important is the signature of a licensed physician, or in some states, a nurse practitioner or physician assistant, who affirms the patient’s wishes and enters the order into the medical record. An unsigned form or one lacking the required physician authorization is medically invalid, regardless of the patient’s intent.
Many states also impose strict witnessing requirements to validate the patient’s signature and intent. This may include two adult witnesses who must not be related to the patient by blood or marriage, and who are also not involved in the patient’s healthcare. A few jurisdictions may require the form to be notarized. The date the physician signs the order establishes when the instruction officially goes into effect, making the physician-signed form an actionable document for all medical personnel.
Distinguishing DNR Orders from Portable Orders
A standard DNR order is narrowly focused, instructing only the withholding of cardiopulmonary resuscitation efforts. This contrasts with Physician Orders for Life-Sustaining Treatment (POLST), or similar forms known as MOLST or POST, which are considered portable medical orders. The POLST is a more comprehensive document that guides care across all settings, including the patient’s home, assisted living facilities, and hospitals.
Unlike a simple DNR, a POLST form includes detailed instructions on a range of treatments beyond CPR, such as intubation, mechanical ventilation, antibiotic use, and artificially administered nutrition. These portable orders are often printed on brightly colored paper, such as pink or green, to ensure they stand out in a patient’s medical records. It provides a broader, more specific framework for a patient’s goals of care, particularly for those with a serious illness or advanced frailty. For individuals primarily cared for outside a hospital, the POLST or its state equivalent may be the more appropriate and actionable document to obtain.
Implementation and Communication in Emergency Settings
For a valid DNR order to be effective during an emergency, its physical presence and immediate visibility are paramount for responding Emergency Medical Services (EMS) personnel. EMS protocols mandate the initiation of CPR unless a valid, written DNR form is presented at the scene. A common, practical recommendation is to keep the original or a legible copy of the form in a highly visible location, such as on the refrigerator door or near the patient’s bedside.
To ensure immediate recognition, many states utilize specific identifiers, such as a state-approved wristband, necklace, or medallion, that is permanently engraved with the words “Do Not Resuscitate – EMS” and an identification number. These medical identifiers immediately alert EMS personnel to the existence of a valid DNR order, even if the paper form is not instantly found. Upon arrival, EMS must locate and verify the form or identifier; if there is any doubt or confusion regarding the order’s validity, personnel are typically required to initiate resuscitation efforts and consult with a medical control physician.
The patient or the legally authorized agent retains the authority to nullify the DNR order at any time, even verbally during an emergency. To formally revoke the order, the patient must destroy the form and immediately inform their physician so the order can be removed from the medical record.