Is an electronic signature valid?

Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, provided intent, consent, attribution, and record retention requirements are met.

Does HIPAA affect how I sign?

Yes. If the form contains protected health information, use a HIPAA-compliant workflow and execute a Business Associate Agreement with the eSignature vendor when PHI is processed.

Who can revoke a DNR?

The patient may revoke at any time if competent; an authorized surrogate may revoke only to the extent permitted by state law and the surrogate’s authority under a power of attorney.

Do EMS always follow this order?

EMS protocols vary. A valid, accessible, and properly signed out-of-hospital DNR increases the likelihood EMS will honor it; local agency policies and state law govern enforcement.

Is notarization required?

Notarization requirements vary by state and agency. Where uncertain, consult local EMS or state statutes to confirm whether notarization or witnesses are required.

How do I update the order?

Create a new signed order and distribute copies; note the revocation of prior orders in the medical record and provide updated copies to EMS and caregivers.

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Indiana Out of Hospital Do Not Resuscitate Declaration and Order

Indiana Out of Hospital Do Not Resuscitate Declaration and Order

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

What the Indiana Out of Hospital Do Not Resuscitate Declaration and Order Is

The Indiana Out of Hospital Do Not Resuscitate Declaration and Order is a legal medical directive that records a patient’s instruction to refuse cardiopulmonary resuscitation (CPR) outside a hospital setting. It documents the patient’s intent, is signed by the patient (or authorized surrogate) and the attending physician or authorized clinician, and is intended for use by emergency medical services and other first responders to withhold CPR consistent with the patient’s wishes.

Why this form matters for patients, families, and providers

A completed Indiana out-of-hospital DNR provides clear, portable evidence of a patient’s decision regarding CPR, reduces uncertainty for EMS and clinicians, and helps align emergency care with the patient’s goals and legal rights under ESIGN/UETA and state law.

Who typically completes and relies on this document

The form is used by patients who decline CPR out of hospital and by clinicians and legal representatives who document and authorize the order.

Patients or Declarants — Individuals with capacity to make medical decisions who explicitly decline out-of-hospital CPR.
Healthcare Agents or Surrogates — Authorized agents acting under a valid healthcare power of attorney when the patient lacks capacity.
Attending Clinicians — Physicians, nurse practitioners, or physician assistants who evaluate, explain, and sign the order.

Keep copies with the patient, provide one to the primary care clinician and place one in the medical record so EMS can follow the order during out-of-hospital emergencies.

Roles Who Can Sign or Authorize the Order

Patient

The adult patient with decision-making capacity signs to indicate informed refusal of CPR. If competent, the patient’s signature is primary evidence of intent and must match identity documentation on record.

Attending Clinician

An authorized physician or clinician documents the medical evaluation and signs to confirm the order. The clinician’s attestation links the patient’s expressed wishes to an actionable medical order for EMS.

Key legal and security references to know

ESIGN / UETA: Electronic signature validity

HIPAA: Protected health information

TLS 1.2/1.3: Encryption in transit

AES-256: Encryption at rest

Audit Trail: Signing metadata retained

BAA Available: Business Associate Agreement

Essential elements of a professional Indiana Out of Hospital DNR

A complete order balances clinical documentation, patient intent, and signature integrity. The template should be clear about who completed it, when it takes effect, and how EMS should act on it.

Patient Identification

Full legal name, date of birth, and other identifiers so EMS and receiving clinicians can reliably match the order to the correct patient record.

Statement of Intent

A concise declaration that the patient refuses out-of-hospital CPR, written in unambiguous language to guide emergency responders.

Clinical Attestation

Signed statement by the attending physician or authorized clinician confirming the patient’s capacity and informed decision or the surrogate’s authority.

Signatures and Dates

Clear signature blocks for the patient (or surrogate) and clinician, each dated; signatures determine enforceability and effective date.

Scope and Limitations

Description of the clinical situations covered (e.g., out-of-hospital cardiac arrest) and any exceptions or instructions for palliative interventions.

Distribution Instructions

Direction for where copies should be kept (home, medical record, given to EMS) so first responders can access the order quickly.

Step-by-step: completing the Indiana Out of Hospital DNR

Follow these steps in order to produce a valid, accessible order for out-of-hospital use.

01

Confirm capacity: Assess and document patient decision-making capacity before proceeding.
02

Complete patient fields: Enter full name, DOB, and contact information accurately.
03

Obtain signatures: Patient or authorized surrogate signs, then clinician signs and dates.
04

Distribute copies: Provide originals/copies to EMS, home caregivers, and the medical record.

How the order is used by EMS and providers

A clear distribution path ensures EMS and clinical staff can locate and follow the DNR during an emergency.

Patient keeps copy: Store in an obvious place at home.
Clinician files copy: Place in the electronic medical record.
EMS notified: Provide copy to local EMS agency where applicable.
Update plan: Review upon major health changes or care transitions.

Configuring a digital workflow for this DNR form

When using an eSignature platform, set up fields and signer order to preserve legal intent and clinical attestation.

Field	Configuration
Patient Signature	Required field, date stamp, signer role 'Patient/Declarant'
Clinician Signature	Required field, include license # and date stamp
Surrogate Authority	Optional conditional field; attach power of attorney when used
Audit Trail	Enable full metadata capture (IP, timestamp, authentication)

Digital signing considerations and technical requirements

Choose an eSignature platform that supports healthcare privacy, strong authentication, and a retained audit trail.

File formats: PDF and DOCX are standard for portability
Authentication: Email + SMS or stronger methods recommended
HIPAA support: BAA must be available for PHI workflows

Ensure the platform provides durable signed documents and export options compatible with electronic health records and EMS protocols.

Timing and review expectations

There is no universal expiration for a DNR order, but best practice is periodic review and re-signing after major clinical changes.

Initial signing:

Sign when the patient expresses informed refusal

Clinical review:

Review at routine care visits or when condition changes

Care transitions:

Update upon hospital discharge or new primary clinician

Annual check:

Consider yearly confirmation of intent

Revocation:

Allow immediate cancellation by patient or authorized agent

Key milestones from decision to EMS action

These sequential milestones describe how a completed order moves from signature to operational use by EMS.

01

Patient Decision

Patient or surrogate documents refusal; signature obtained.

02

Clinician Order

Attending clinician signs medical order to withhold CPR.

03

Record Placement

Order filed in medical record and copy given to patient.

04

EMS Recognition

First responders locate and follow the order in the field.

Common mistakes to avoid when preparing this order

Using vague language that fails to specify 'out-of-hospital CPR' can lead to inconsistent EMS action and confusion.
Failing to include clinician identification, license number, or date undermines the form’s enforceability with medical services.
Not distributing copies to EMS or caregivers means first responders may not find the order during an emergency response.
Allowing mismatched or unsigned signature blocks (e.g., initials only) can render the order unenforceable in practice.

Risks and legal consequences of an incorrect or incomplete order

Medical error: Potential for unwanted resuscitation

Legal exposure: Provider or facility liability risk

EMS refusal: EMS may default to full resuscitation

Family disputes: Increased risk of legal challenges

Record invalidation: Unsigned or mismatched forms may be disregarded

Delayed care: Ambiguity can slow emergency decision-making

eSignature vendor comparison for completing and storing DNR orders

Compare vendor pricing and key capabilities relevant to healthcare forms and PHI handling; signNow is listed first per comparison conventions.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently asked questions about the Indiana Out of Hospital DNR

Answers to common questions about validity, signatures, revocation, and digital completion of out-of-hospital DNR orders.

Need help? Contact support

Is an electronic signature valid?
Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, provided intent, consent, attribution, and record retention requirements are met.
Does HIPAA affect how I sign?
Yes. If the form contains protected health information, use a HIPAA-compliant workflow and execute a Business Associate Agreement with the eSignature vendor when PHI is processed.
Who can revoke a DNR?
The patient may revoke at any time if competent; an authorized surrogate may revoke only to the extent permitted by state law and the surrogate’s authority under a power of attorney.
Do EMS always follow this order?
EMS protocols vary. A valid, accessible, and properly signed out-of-hospital DNR increases the likelihood EMS will honor it; local agency policies and state law govern enforcement.
Is notarization required?
Notarization requirements vary by state and agency. Where uncertain, consult local EMS or state statutes to confirm whether notarization or witnesses are required.
How do I update the order?
Create a new signed order and distribute copies; note the revocation of prior orders in the medical record and provide updated copies to EMS and caregivers.

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