Can a DNR be signed electronically?

Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and state UETA laws, provided the signer demonstrates intent, consents to electronic records, attribution is clear, and the record is retained in a retrievable format.

Does HIPAA affect electronic DNR handling?

Yes. DNR documents contain protected health information and must be stored and transmitted in compliance with HIPAA; organizations should execute a Business Associate Agreement when using third-party eSignature providers.

Are witnesses or notarization required?

It depends on state law and facility policy. Some states or facilities require witnesses or notarization for advance directives; confirm local rules before finalizing the form.

How do I change or revoke a DNR?

A patient with capacity can revoke or amend a DNR at any time, typically by signing a revocation form or completing a new directive; clinicians should document the revocation in the medical record immediately.

What if the patient lacks decision-making capacity?

If a patient lacks capacity, a legally authorized surrogate or agent may complete or confirm a DNR according to state surrogate decision-making laws and documented authority such as a durable power of attorney for healthcare.

How should signed DNRs be stored?

Store signed DNRs in the patient’s EHR with metadata (signer, date, clinician attestation). Ensure retention policies meet HIPAA and any applicable state requirements.

Electronic Signature
Templates
Healthcare
Healthcare DNR Template

Healthcare DNR Template

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

Healthcare Do Not Resuscitate (DNR) Order

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

Patient Information

Address Phone Emergency Contact

DNR ORDER — Statement of Intent

I, , being of sound mind, hereby direct that in the event of cardiac or respiratory arrest I do not want cardiopulmonary resuscitation (CPR) to be attempted.

Check the treatments to be withheld in the event of cardiac or respiratory arrest (check all that apply):

Withhold chest compressions (CPR)
Withhold endotracheal intubation and mechanical ventilation
Withhold external electrical defibrillation (AED)
Withhold advanced airway procedures (e.g., cricothyrotomy)

Scope of Care and Limitations

This order applies only to attempts at cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. It does not prohibit the provision of other medical treatments unless so indicated below.

Additional instructions (select as applicable):

Allow comfort-focused care and symptom control (e.g., oxygen, analgesia, anti-anxiety medications)
Allow antibiotics for infection unless directly prolonging dying
Allow IV fluids and nutrition
Restrict transfer to hospital when such transfer would subject me to burdensome interventions inconsistent with this DNR order

Additional Directives

Other instructions, preferences, limitations, or explanatory statements

Effectiveness, Revocation, and Duration

This DNR order becomes effective immediately upon signature by the patient (or legally authorized representative) and the date entered below and constitutes a medical order. It remains in effect until revoked by the patient or until a later effective date specified below.

Authorization expiration date (optional)

Revocation: I understand I may revoke this DNR order at any time by informing my attending physician, other treating clinicians, or by destroying this document. Oral revocation conveyed to a treating clinician is sufficient to terminate this order.

Healthcare Provider Information

Attending Provider (printed name) Provider license or ID number Facility

HIPAA / Privacy Acknowledgment

I acknowledge that I have been informed of my privacy rights and the handling of my medical information in connection with this DNR order.

Patient Understanding and Certification

I certify that I understand the nature and consequences of this DNR order, that reasonable alternatives and expected outcomes have been explained to me, and that my signature below is made voluntarily. By signing I direct healthcare providers to follow the instructions contained herein.

Initials to confirm understanding of DNR scope

Patient Name:

Signature:

Date:

If signed by a legal guardian or representative, relationship to patient:

What a Healthcare DNR Template Is and where it fits

A Healthcare DNR Template (Do Not Resuscitate) is a standardized medical directive that records a patient’s decision to decline cardiopulmonary resuscitation (CPR) and advanced life support in the event of cardiac or respiratory arrest. It formalizes patient preferences for emergency care, names any relevant surrogate decision-maker, and clarifies clinical orders for first responders and hospital staff. Because DNR directives interact with medical records and care decisions, they are completed within healthcare workflows, coordinated with advance directives, and retained under health privacy rules such as HIPAA.

Why a clear, consistent Healthcare DNR Template matters

A well-structured DNR form reduces confusion during emergencies, documents patient intent, and helps clinicians act in accordance with a patient’s wishes.

Who typically completes and relies on a Healthcare DNR Template

Clinical teams, patients or their legally authorized representatives, and facility administrators are common participants when completing a DNR directive.

Patients and surrogates: Complete preferences and designate a decision-maker; form documents individual medical choices.
Treating clinicians: Verify decisional capacity, confirm orders, and enter the directive in the medical record.
Emergency personnel and facility staff: Use the form to guide resuscitation and code-status actions during urgent care.

Proper completion and placement in the chart ensures the DNR is visible during emergent care and honored across care settings.

Essential sections to include in a professional Healthcare DNR Template

A comprehensive template balances clinical clarity with legal formality and should fit into electronic health records and paper workflows.

Patient ID

Full name, date of birth, medical record number and a clear identifier to match clinical charts and emergency bracelets.

Decision Statement

Explicit, unambiguous instruction that CPR and advanced life support are to be withheld in the event of cardiac or respiratory arrest.

Authority

Name and contact for the patient or legally authorized representative who is issuing or confirming the directive.

Clinical Verification

Space for clinician attestation of patient capacity or documentation of the surrogate decision process, plus date and time.

Signatures

Signature blocks for patient or surrogate and attending clinician, with dates and witness or notary area if required.

Integration Notes

Instructions for entering the DNR into the electronic health record, emergency bracelet instructions, and first-responder guidance.

Required information typically captured on a Healthcare DNR Template

Patient name: Full legal name

Date of birth: MM/DD/YYYY

Medical record: MRN or hospital ID

Decision-maker: Name and relationship

Clinician name: Attending physician

Signature date: Date signed

Simple step-by-step: completing a Healthcare DNR Template

Follow these sequential steps to document patient wishes and place the DNR in active clinical use.

01

Confirm identity: Verify patient identity and MRN.
02

Assess capacity: Document patient decision-making capacity or surrogate authority.
03

Complete form: Enter choices, clinician attestation, and dates.
04

File and notify: Add to EHR and inform care team.

How to configure a digital DNR workflow

Basic configuration settings let you collect signatures, verify identity, and route the completed directive into the medical record.

Field	Configuration
Patient identifiers	Auto-fill from EHR via integrations
Signer order	Patient or surrogate then clinician
Authentication	Use SMS or institutional SSO
Storage	Save PDF to EHR and archive

Typical routing: from form completion to clinical use

A clear routing path ensures the DNR is both legally effective and clinically visible when needed.

Complete form: Patient or surrogate fills and signs
Clinician review: Attending physician verifies and signs
EHR upload: Attach signed PDF to the medical record
Notify team: Care team alerted and bracelet updated

Digital signing and eSubmission considerations

Ensure the chosen platform supports secure authentication, a tamper-evident audit trail, and HIPAA-compliant handling of protected health information.

Authentication: Support for SMS, email PIN, or SSO
Audit trail: Capture timestamp, IP, and actions
HIPAA: Business Associate Agreement available

Verify platform encryption (TLS 1.2/1.3; AES-256 at rest), BAA availability, and integration options to send the signed DNR PDF directly to the electronic health record.

Timing and processing expectations for DNR directives

Timing varies by clinical need; document and notification steps should be completed promptly to ensure the directive is actionable.

Immediate effect:

Forms signed by competent patients take effect immediately

Clinician review:

Should occur the same day as signature

EHR entry timing:

Upload within 24 hours to ensure visibility

Notification window:

Care team and primary provider notified within 24 hours

Periodic review:

Reassess during major care changes or annually

Common mistakes to avoid when preparing a Healthcare DNR Template

Using ambiguous language such as 'comfort measures only' without specifying CPR refusal and clarifying scope of care.
Failing to record the signer’s capacity assessment or surrogate authority, which can create legal uncertainty during emergencies.
Not placing the signed DNR in the electronic chart immediately, delaying access for emergency and admitting staff.
Omitting contact information for the surrogate or legal representative, making it harder for clinicians to confirm decisions.

Consequences and risks when a DNR is incorrect or incomplete

Invalid directive: May not be honored clinically

Delayed care: Emergency response confusion

Civil liability: Potential for disputes or litigation

Regulatory exposure: HIPAA or state violations risk

Family conflict: Increased chance of contested decisions

Operational burden: Additional administrative review

Realistic scenarios illustrating use of a Healthcare DNR Template

Two typical scenarios show how a completed DNR affects care and documentation.

Hospital scenario

A hospitalized patient signs a DNR after a goals-of-care conversation with their physician

Clerk uploads signed PDF to the EHR, links an alert to the chart
During an in-hospital arrest, staff reference the chart and withhold CPR per the documented order, avoiding unwanted interventions.

Long-term care scenario

A nursing home resident appoints a health care agent and signs a DNR with two witnesses

The facility places the DNR in the resident’s paper and electronic file
On transfer to the hospital, staff send a copy with the transfer packet so the directive continues to guide inpatient care.

Representative eSignature vendor comparison for DNR workflows

Platform choices affect authentication, compliance, and cost. The table shows starting prices and key HIPAA-related capabilities across common vendors.

	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 by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about the Healthcare DNR Template

Answers to common questions about validity, signatures, electronic submission, and changing a DNR.

Need help? Contact support

Can a DNR be signed electronically?
Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and state UETA laws, provided the signer demonstrates intent, consents to electronic records, attribution is clear, and the record is retained in a retrievable format.
Does HIPAA affect electronic DNR handling?
Yes. DNR documents contain protected health information and must be stored and transmitted in compliance with HIPAA; organizations should execute a Business Associate Agreement when using third-party eSignature providers.
Are witnesses or notarization required?
It depends on state law and facility policy. Some states or facilities require witnesses or notarization for advance directives; confirm local rules before finalizing the form.
How do I change or revoke a DNR?
A patient with capacity can revoke or amend a DNR at any time, typically by signing a revocation form or completing a new directive; clinicians should document the revocation in the medical record immediately.
What if the patient lacks decision-making capacity?
If a patient lacks capacity, a legally authorized surrogate or agent may complete or confirm a DNR according to state surrogate decision-making laws and documented authority such as a durable power of attorney for healthcare.
How should signed DNRs be stored?
Store signed DNRs in the patient’s EHR with metadata (signer, date, clinician attestation). Ensure retention policies meet HIPAA and any applicable state requirements.

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