Do Not Resuscitate Order Form

A do not resuscitate order form is also known as a DNR. It instructs medical professionals that the patient does not wish to receive certain medical procedures (such as CPR) to save their life. The wording involved in a do not resuscitate form may vary depending on the state where you live. Once completed and signed by the patient, a copy should be given to the patient's doctor as well as to the hospital. DNRs are easy to complete, but it's important to make sure it is properly completed so that your wishes are honored.

What is a DNR form (Do Not Resuscitate)?

A Do Not Resuscitate order (DNR) is a medically related document that instructs medical personnel to cease performing life-sustaining treatment such as cardiopulmonary resuscitation (CPR), endotracheal intubation, and defibrillation. Most patients who initiate a DNR are terminally ill. People may also use them if they want to stay off life-support in the event of a coma or other serious injury or illness.

A Do Not Resuscitate form will be different for each state, although they all include similar information. A copy of the completed and signed form should be kept in the patient’s file at their physician’s office and hospitals. People who have a standing DNR order should also consider wearing a medical bracelet or necklace that indicates they have a Do Not Resuscitate standing.


In the United States, Canada, United Kingdom, and New Zealand, “Do Not Resuscitate” and DNR are the most commonly used terms.  Other similar terms that are used in some regions include:

  • DNI - Do Not Intubate
  • No Code
  • DNAR - Do Not Attempt Resuscitation
  • NFR - Not For Resuscitation
  • NTBR - Not to Be Resuscitated
  • Not for 222 (UK only, where 222 is used as the phone number for the emergency resuscitation team)

Who should have a DNR order form?

Anyone who feels strongly about not being resuscitated or intubated once their breathing and heart stops should consider having a form.

People with terminal illnesses or who are at high risk for stroke, cardiac arrest, or respiratory arrest often consider getting a DNR.

How do I get a DNR form?

Each state has different legal requirements about what must be included in a DNR.  Verify your state’s laws to make sure that your DNR complies with all requirements.

Do Not Resuscitate orders  are usually one-page documents that are fairly simple to prepare and execute.  They can be included as part of advance directives or advanced healthcare directives.  A DNR can also be included in a living will.

You can create a DNR online with a template or seek legal counsel to draft one for you.

State Guidelines

Can a state DNR form be used in a nursing facility or hospice?

Yes, a state DNR should be provided to the care facility and a copy should be clearly posted or maintained by the patient.

Is a California DNR approved in other states?

Each state has its own DNR laws.  If you are traveling out of state, you should check that state’s public health department to determine what you will need to do to ensure that your DNR wishes will be followed.

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Do Not Resuscitate Order

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Sample Do Not Resuscitate Order


Sample Do Not Resuscitate Order

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