When the patient has capacity they sign the DNR. If incapacitated, a legally authorized surrogate or someone named in an advance directive may sign under applicable state law; the ordering clinician must document authority.

Is notarization required?

Notarization is generally not required for hospital DNR orders; however, some jurisdictions or registries may have specific formalities. Confirm local EMS or state rules if the DNR will be used outside the facility.

Can a DNR be e-signed?

Electronic signatures are valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and reliable record retention are satisfied and any industry-specific disclosure requirements are met.

How do I revoke a DNR?

A patient or authorized surrogate can revoke a DNR at any time by notifying the clinician; the clinician must document revocation, remove or update the order in the medical record, and communicate changes to care teams and EMS.

What if EMS encounters an old conflicting order?

EMS follows current valid orders presented during response; if a conflict exists, they follow jurisdictional protocols. Maintain clear, accessible DNR documentation and state registry entries to reduce conflicting guidance.

How long is a DNR valid?

Validity depends on the order language and clinical context; orders remain in force until revoked or superseded, and should be reviewed when clinical status or patient preferences change and at care transitions.

Electronic Signature
Templates
Miscellaneous
Do Not Resuscitate Order

Do Not Resuscitate Order

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DO NOT RESUSCITATE ORDER

Patient Name: Date of Birth: Medical Record No.:

Patient Address:

ORDER

It is the medical order of the attending physician that, in the event of cardiac or respiratory arrest of the patient identified above, cardiopulmonary resuscitation (CPR) shall not be attempted. This order specifically directs withholding of the following resuscitative measures in the event of arrest: chest compressions, endotracheal intubation or advanced airway placement, assisted ventilation (bag-valve-mask or mechanical ventilation initiated in arrest), defibrillation, and administration of cardiotonic or vasoactive drugs intended as resuscitative measures.

This Do Not Resuscitate Order does not prohibit the provision of comfort care, palliative measures, analgesia, oxygen administration when indicated for comfort, intravenous access for medication administration for comfort, or routine treatment of reversible conditions as clinically indicated unless otherwise specified below.

SCOPE AND SETTINGS

This order shall be effective in the following settings (check all that apply):

Apply while inpatient at this facility Apply in all outpatient and emergency settings, including emergency medical services (EMS) Apply only under specified conditions:

DECISION MAKING / AUTHORITY

The basis for this order (check one):

Patient has capacity and personally requested this order Order based on written advance directive or living will Patient lacks capacity; order authorized by legally authorized representative

If authorized by representative, provide name and legal authority:

INDICATIONS, LIMITATIONS, AND CLINICAL NOTES

Describe indications, clinical limitations, or additional instructions:

REVOCATION / EXPIRATION

This order remains in effect until revoked by the patient, the patient’s legally authorized representative, or the ordering clinician. Revocation may be verbal or written and shall be documented in the medical record. If temporary or time-limited, specify expiration:

LEGAL AND ADMINISTRATIVE PROVISIONS

This medical order is issued by the attending physician and constitutes a physician's order to withhold resuscitation in accordance with applicable law and institutional policy. Health care providers receiving a copy of this order shall comply with its terms. The existence of this order does not alter the provision of other appropriate medical care unless explicitly stated. The facility and providers are entitled to rely on the representations made herein regarding authority and consent.

By signing below, the patient or legally authorized representative acknowledges that the nature and consequences of a Do Not Resuscitate Order have been explained, that reasonable alternatives have been discussed, and that questions have been answered to the best of the signer’s ability. The attending physician attests that the clinical rationale and the informed-consent process (where applicable) have been documented in the medical record.

WITNESS ATTESTATION (IF REQUIRED)

Witness Name and Relationship: Witness Signature (if applicable):

ATTENDING PHYSICIAN / ORDERING PRACTITIONER

Physician/Practitioner Printed Name: License Number / NPI: Facility:

Patient / Legally Authorized Representative:

Printed Name:

Signature:

Date:

Attending Physician / Ordering Practitioner:

Printed Name:

Signature:

Date:

What a Do Not Resuscitate Order Is and When It Applies

A Do Not Resuscitate Order (DNR) is a medical order indicating that cardiopulmonary resuscitation (CPR) should not be performed if a patient stops breathing or their heart stops. DNR orders are completed by a clinician in consultation with the patient or an authorized decision-maker and become part of the medical record, directing emergency and inpatient care teams about life-saving interventions the patient declines.

Why a Clear DNR Order Matters

A properly completed DNR clarifies patient treatment preferences, reduces unwanted interventions, and guides emergency responders and hospital staff during critical events. It protects patient autonomy while minimizing confusion among clinicians and family members about resuscitation wishes.

Who Typically Completes or Relies on a DNR

Health systems, emergency medical services, long-term care facilities, and patients or legally authorized surrogates rely on DNR orders to document resuscitation preferences.

Patients with advanced illness, frailty, or terminal diagnoses who decline CPR or life-extending interventions
Legally authorized surrogates acting under an advance directive or state law when the patient lacks capacity
Physicians, nurse practitioners, and emergency personnel who must implement the order in acute settings

Clinicians, EMS personnel, facility administrators, and legal representatives all refer to the DNR to make rapid, lawfully supported treatment decisions.

Primary Signers and Responsible Parties

Patient

When capable, the patient signs or verbally confirms a DNR and the clinician documents capacity and informed refusal. If the patient cannot sign, an advance directive or prior written instructions should guide decisions.

Clinician

A licensed physician or permitted clinician must issue or countersign the DNR as required by state law or facility policy; the clinician documents clinical discussion, diagnosis, and rationale for placing the order.

Essential Data Elements on a Professional DNR

Patient Name: Full legal name

Date of Birth: MM/DD/YYYY

Medical Record: Hospital or facility ID

Ordering Clinician: Name and licensure

Signature Date: MM/DD/YYYY

Witness/Verifier: Witness or staff verifier

Consequences of an Incorrect or Missing DNR

Unwanted CPR: Patient receives interventions they refused

Legal Liability: Civil claims for failure to follow valid order

Criminal Exposure: Rare prosecution for intentional harm

Emergency Delays: Confusion can delay appropriate palliative care

Insurance Impacts: Coverage disputes when documentation is incomplete

Facility Penalties: Regulatory sanctions for noncompliance

Common Pitfalls When Preparing a DNR

Using informal notes instead of a formal clinician-signed DNR that EMS and hospitals will recognize and follow
Failing to document patient capacity and the informed discussion that led to the DNR decision
Not updating or reconciling multiple records so old or conflicting orders remain accessible to staff
Assuming a prior advance directive is current without confirming its applicability to the present clinical situation

How to Complete a DNR: Step-by-Step

Follow a clear sequence to ensure the DNR is valid, accessible, and actionable by care teams and EMS.

01

Confirm Capacity: Assess and document the patient's decision-making ability
02

Discuss Options: Explain CPR outcomes, alternatives, and palliative care
03

Obtain Order: Clinician places the DNR in the medical chart
04

Distribute Copies: Provide notice to EMS, family, and receiving facilities

Typical DNR Workflow Across Care Settings

DNR orders follow a consistent flow to communicate patient wishes from inpatient units to EMS and post-acute settings.

Initiation: Patient or surrogate requests or clinician proposes DNR
Documentation: Order recorded in electronic health record
Authentication: Clinician signs; witness requirements applied if needed
Communication: DNR status shared with EMS, care teams, and registries

Core Components of a Professional DNR Order

A complete DNR contains structured language and clear signatory information so it is unambiguous for clinical teams and enforceable under applicable law.

Patient Identification

Includes full legal name, date of birth, and medical record or other identifier to ensure the order applies to the correct individual and avoids misapplication in emergency care settings.

Statement of Intent

Plain-language declaration that the patient declines cardiopulmonary resuscitation and other specified life-sustaining measures so clinicians understand the scope and limits of permitted care.

Scope of Order

Defines whether the DNR applies only to CPR or also to advanced airway management, intubation, defibrillation, or other interventions, preventing ambiguity during a crisis.

Clinician Authorization

Name, license, and signature of the ordering clinician with date and time, documenting that a qualified professional issued the medical order in accordance with facility policy.

Surrogate or Consent

If the patient lacks capacity, identifies the authorized surrogate or references the controlling advance directive, including legal authority and basis for surrogate decision-making.

Visibility & Placement

Clear instruction about where the order will be placed and how it is communicated to EMS and receiving facilities so the DNR is visible and actionable when needed.

Electronic Workflow Settings for a DNR

Configure an electronic DNR workflow to ensure valid signatures, secure storage, and fast access by authorized clinicians.

Field	Configuration
Patient Name	Required, auto-fill from EHR
Ordering Clinician	Clinician must authenticate to sign
Signature Date	Automatically timestamped
Registry Upload	Optional push to state/local registry

Technical Considerations for eDNR and eSubmission

Electronic DNRs should be hosted on platforms that support secure authentication, audit trails, and health-data protections such as HIPAA.

Authentication: Multi-factor or clinician SSO
Audit Trail: Timestamp, IP, and signer identity
Formats: PDF/A and EHR-native records

Timing and Review Expectations for a DNR

DNR orders should be current, reviewed periodically, and promptly updated after changes in patient capacity, goals, or care transitions.

Immediate Entry:

Place the DNR order in the chart at the time of clinician authorization

Post-Admission Review:

Review within 24–48 hours of admission or care transition

Periodic Reconfirmation:

Reassess when clinical status or goals change

Registry Submission:

Submit to state/local registry when required or recommended

Revocation Processing:

Process and document revocation immediately upon patient or surrogate request

eSignature Vendor Comparison for DNR Execution and Storage

Common eSignature providers vary by price, trial availability, and compliance features that matter for clinical documents and HIPAA-protected health information.

	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
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Real-World Examples of Digital Orders and Workflows

Healthcare organizations and small providers use electronic orders and signature platforms to capture DNR decisions and distribute them efficiently across care teams.

Optica Ventures

Optica implemented online forms to reduce turnaround for clinical orders and consent documentation.

The team centralized signed orders.
The result improved retrieval and reduced administrative delays during patient handoffs by ensuring orders traveled with the patient and appeared in the receiving chart.

Fertility Centers of Illinois

The center adopted an e-sign platform for clinical consents and orders to align with their EHR workflows.

Integration enabled automatic attachment to the medical record.
This strengthened compliance, preserved audit trails, and made clinician-signed directives available to authorized staff without paper handling.

Common Questions About Do Not Resuscitate Orders

Answers to frequent practical and legal questions about completing, validating, and updating DNR orders in the United States.

Need help? Contact support

Who may sign a DNR?
When the patient has capacity they sign the DNR. If incapacitated, a legally authorized surrogate or someone named in an advance directive may sign under applicable state law; the ordering clinician must document authority.
Is notarization required?
Notarization is generally not required for hospital DNR orders; however, some jurisdictions or registries may have specific formalities. Confirm local EMS or state rules if the DNR will be used outside the facility.
Can a DNR be e-signed?
Electronic signatures are valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent, consent, attribution, and reliable record retention are satisfied and any industry-specific disclosure requirements are met.
How do I revoke a DNR?
A patient or authorized surrogate can revoke a DNR at any time by notifying the clinician; the clinician must document revocation, remove or update the order in the medical record, and communicate changes to care teams and EMS.
What if EMS encounters an old conflicting order?
EMS follows current valid orders presented during response; if a conflict exists, they follow jurisdictional protocols. Maintain clear, accessible DNR documentation and state registry entries to reduce conflicting guidance.
How long is a DNR valid?
Validity depends on the order language and clinical context; orders remain in force until revoked or superseded, and should be reviewed when clinical status or patient preferences change and at care transitions.

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