A Do Not Resuscitate (DNR) order is a specific medical instruction informing healthcare professionals, including emergency responders, not to perform cardiopulmonary resuscitation (CPR) if a person’s heart stops beating or they stop breathing. CPR encompasses interventions such as chest compressions, artificial ventilation, and electrical defibrillation. Unlike a living will, which covers general end-of-life care preferences, a DNR is a physician’s order that medical staff must follow immediately. The legal framework governing the DNR is determined entirely by state law, meaning the process is highly variable across the United States.
State-Specific Acquisition Methods
Acquiring the correct DNR form requires using the official, state-mandated template to ensure validity. Generic forms or those from other states may be disregarded by emergency medical services (EMS) personnel. Since the DNR is considered a physician’s order in many states, the process often begins with a conversation between the patient and their doctor.
You can obtain the document directly through a healthcare provider, such as a physician’s office, a hospital’s admissions department, or a hospice and palliative care team. Many state health departments also provide the necessary forms directly on their official websites for public download. These are approved state templates, sometimes designated as “Out-of-Hospital DNR” forms, designed to be recognized by first responders. Always confirm that the form is the current, legally compliant version for your specific jurisdiction, as failure to do so can invalidate the patient’s wishes.
Legal Completion and Execution Requirements
Transforming the blank document into a legally executable medical order requires strict adherence to state-specific signature and witnessing requirements. The patient or their legally authorized healthcare agent must sign the form, confirming their informed consent. The DNR must then be signed by the patient’s attending physician. This physician’s signature is non-negotiable, as it converts the patient’s request into a binding medical order to withhold specific medical treatments.
Many states require the form to be witnessed by two competent adults who observe the signing and attest that the patient appeared to be of sound mind and free from duress. To prevent conflicts of interest, the law in most states disqualifies certain individuals from acting as a witness.
Disqualified Witnesses
These excluded individuals often include:
- The patient’s relatives by blood or marriage.
- Anyone entitled to a portion of the patient’s estate.
- The healthcare provider who is writing the order.
While most DNR orders do not require notarization, some jurisdictions permit a notary public’s signature to replace the requirement for two witnesses, offering an alternative method of validation.
Ensuring Accessibility and Storage
A legally executed DNR order is only effective if emergency personnel can find it immediately during a crisis. The original document should be stored in a highly visible and easily accessible location in the home, such as taped to the front of the refrigerator or near the patient’s bed. Ensure copies of the completed form are included in the patient’s medical record at their primary care physician’s office, specialists, and hospitals. This ensures the order is incorporated into the broader healthcare system.
Many states have established systems for identifying patients with a DNR order outside of a healthcare facility to provide clear notice to EMS personnel. This often involves state-specific identification items, such as a brightly colored wristband, neck medallion, or wallet card. The use of these standardized identification methods is recommended because they are immediately recognizable by first responders and serve as physical evidence of the order’s existence. Sharing copies with family and caregivers is also important, as they can quickly communicate the patient’s status to emergency dispatchers.