Do Not Resuscitate Form (DNR)

Create a Do Not Resuscitate Form (DNR)

Patient Full Name

Write the patient’s complete legal name as it appears on their government-issued ID, including first name, middle name (if any), and last name. Avoid using nicknames or abbreviations to ensure accuracy in legal documents. This name will be used for all official purposes, so it's important that it matches their legal identification.

Not the form you're looking for?

Try our AI document generator to create a custom document

Powered by AI • Create custom legal documents instantly

What is a Do Not Resuscitate Form (DNR)?

A Do Not Resuscitate Form (DNR) is a legally binding document that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event that a patient's breathing or heartbeat stops. This document is crucial for individuals who wish to decline potentially life-extending procedures due to terminal illness, advanced age, or the desire for a natural end of life without aggressive medical interventions. It ensures that a person's medical treatment preferences are respected and followed by medical personnel, thereby providing peace of mind to both the individual and their family members. The decision to implement a DNR requires careful consideration and, typically, consultation with a healthcare provider to understand its implications fully.

Key Features

✓Clearly specifies the individual's wishes regarding CPR in critical medical situations.
✓Legally recognized by healthcare professionals and emergency responders.
✓Can be easily integrated into an individual's broader medical and end-of-life care planning.
✓Includes provisions for revocation or modification as the individual's health status or preferences change.
✓Designed to respect and uphold the autonomy of the patient in making end-of-life care decisions.
✓Facilitates conversations between patients, their families, and healthcare providers about treatment preferences.

Important Provisions

  • A declaration statement clearly articulating the refusal of CPR and other resuscitative measures.
  • Identification information of the individual making the declaration, ensuring there is no ambiguity about whose wishes are represented.
  • Signatures from the individual (or legal representative) and a witness or healthcare provider as required by state laws.
  • Instructions for revocation should the individual decide to change their preferences at a later date.

Pros and Cons

Pros

  • +Ensures an individual's end-of-life wishes are respected, potentially avoiding unwanted medical interventions.
  • +Reduces the emotional burden on family members during critical moments by having clear, documented instructions.
  • +Helps avoid conflicts or confusion among healthcare providers about the desired approach to end-of-life care.
  • +Provides legal clarity and certainty regarding the patient's preferences, reducing liability for medical personnel.
  • +Can be part of comprehensive advance care planning that respects patient autonomy.

Cons

  • -Requires thoughtful consideration and discussion with healthcare providers to ensure it aligns with the individual's wishes.
  • -May not be immediately accessible in all emergency situations unless properly registered or communicated.
  • -Could lead to family disagreements if not all members understand or agree with the decision.

Common Uses

  • For individuals with terminal illnesses who wish to avoid aggressive life-saving measures.
  • By elderly patients who prefer natural death over prolonged life support in case of severe health events.
  • In situations where quality of life considerations outweigh the potential benefits of resuscitative efforts.
  • As part of advance care planning by individuals who have strong convictions about their end-of-life care preferences.
  • For patients with chronic conditions who wish to limit interventions that may prolong suffering without improving quality of life.
  • By individuals as part of their living will or advance directive documentation.

Frequently Asked Questions

Obtaining a DNR form typically involves consulting with your healthcare provider. They can provide you with state-specific forms and guidance on how to complete them according to local laws. In many cases, these forms require signatures from both you and your physician.
While all states recognize DNR orders in some form, specific requirements and recognition can vary. It's important to review your state’s regulations and ensure your DNR form complies with local laws.
Yes, you can revoke or modify your DNR order at any time. It is advisable to discuss any changes with your healthcare provider and ensure that new documentation reflects your current wishes.
Individuals facing terminal illnesses, those with serious chronic conditions impacting quality of life, elderly persons considering their end-of-life care options, or anyone wishing to avoid certain life-extending procedures should consider discussing a DNR with their doctor.
Not necessarily. A DNR specifically refers to not receiving CPR if your heart stops or you stop breathing. Other forms of treatment can still be provided unless specified otherwise in an advance directive or similar documentation.

Do Not Resuscitate Form (DNR) Preview
View Document
Click to view

About this document

A Do Not Resuscitate Form (DNR) is a legal document that instructs healthcare providers not to perform CPR.

Create a Do Not Resuscitate Form (DNR)

This document is designed to comply with the laws of all 50 states.

Published Aug 26, 2025
0 Comments
0 Downloads
PDF
Word

Community Discussion

Share your experience and help others

0

Comments (0)

Leave a Comment

Your email will not be displayed publicly. It is used for validation purposes only and will never be used to send unwanted emails or sold to third parties.

No comments yet. Be the first to comment!

Legal Notice: Comments are personal opinions and do not constitute legal advice. Always consult a qualified attorney for matters specific to your situation.