Can an OOHDNR be created electronically?

Yes. Electronic execution is permissible where state and agency rules allow, subject to ESIGN and UETA standards for intent, consent, attribution, and retention.

Is a clinician signature always required?

Many jurisdictions require clinician attestation that the OOHDNR is medically appropriate; verify local EMS and state requirements to confirm who must sign.

Do I need a notary or witnesses?

Witness and notary requirements vary by state. Some states require witnesses or notarization; confirm with the local health department or legal counsel.

How do I ensure EMS will honor the form?

Register the OOHDNR with local EMS registries when available, distribute copies to first responders, and ensure the form uses accepted wording and clinician attestation.

Can a surrogate sign an OOHDNR?

Yes, when permitted by state law and documented authority; include proxy relationship and legal basis, and confirm authentication to minimize disputes.

How long should I keep the signed form?

Retain the form in the medical record and locally per HIPAA (6 years) and organization policy; consider keeping copies longer for legal defense.

Electronic Signature
Templates
Healthcare
Healthcare OOHDNR Form

Healthcare OOHDNR Form

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

Healthcare OOHDNR Form

Patient Information

Patient Name:

Date of Birth Gender

Male Female Other / Prefer not to say

Address Primary Phone Emergency Contact

Advance Directive — Out-of-Hospital Do Not Resuscitate Order

By completing and signing this form I affirm that I am the patient or the patient's lawful agent and I direct that when the patient is found pulseless and apneic outside of a hospital setting, emergency medical services personnel and other authorized responders shall withhold cardiopulmonary resuscitation (CPR) and other invasive resuscitative measures as indicated below. This document constitutes an out-of-hospital DNR order to be honored by emergency responders and other pre-hospital personnel.

Effective Date:

Medical Interventions to be Withheld (check all that apply)

Cardiopulmonary resuscitation (chest compressions and rescue breathing) Advanced airway management and endotracheal intubation Defibrillation/cardioversion IV/IO/IM medications administered for the purpose of resuscitation Allow all measures necessary for comfort care and symptom management (oxygen, analgesia, suctioning for airway secretions)

Scope and Instructions to Emergency Personnel

If the patient is found without a pulse and not breathing, authorized pre-hospital personnel shall not initiate or continue resuscitative measures specified above. This order applies outside of inpatient hospital settings and during transport; in-hospital treatment may be governed by separate facility policies. The patient has the right to receive other medical care consistent with selected interventions and comfort-focused treatment.

Legal Acknowledgment and Right to Revoke

I understand that this OOHDNR order is voluntary. I understand I may revoke or amend this order at any time by expressing my intent to revoke to a treating clinician, by destroying this document, or by providing a signed written revocation. I further understand that if I regain consciousness or demonstrate signs of return of spontaneous circulation, this order does not require withdrawal of customary medical care unrelated to resuscitation.

If signed by a legal guardian, health care agent, or other authorized surrogate, provide name and relationship below and ensure documentation of authority is available upon request.

Surrogate or Guardian Name (if applicable)

Medical History and Current Medications

Current Medications Allergies Chronic Conditions (select applicable)

Heart disease Chronic lung disease / COPD Active cancer Dementia or cognitive impairment Other (describe below)

Other relevant medical information

Insurance and Responsible Party

Insurance Provider

Physician Certification (Clinical Order)

The following information documents the clinician's order to implement this out-of-hospital DNR. Healthcare systems, EMS agencies, or other authorized responders may require clinician confirmation. The clinician's printed name, license, and contact information below are provided for verification. This section documents the clinician's clinical assessment and order; validity of the OOHDNR may be governed by applicable law and local policy.

Clinician / Authorized Practitioner Name

Clinician attestation (check one):

I attest that the patient had decision-making capacity at the time of this order I attest that a lawful surrogate/guardian authorized the order and documentation of authority is on file

Date of Clinical Order

Witness Acknowledgment

Witnesses are recommended to attest that the patient appeared to have capacity or that the surrogate signed in their presence. Witnesses should not be a primary beneficiary of the patient's estate where such conflict exists.

Witness 1 — Printed Name Witness 2 — Printed Name

Privacy and Authorization

By signing below I acknowledge that my protected health information associated with this order may be shared with emergency responders and healthcare providers for the purpose of treatment, verification, and lawful disclosure necessary to implement this OOHDNR. I understand that this authorization may be limited by law and that I may request a copy of this document.

Authorization expiration date (if any):

Additional Instructions / Provider Notes

Patient Name:

Signature:

Date:

If signing as patient's legal guardian or health care agent, indicate relationship and authority:

What the Healthcare OOHDNR Form Is and where it applies

The Healthcare OOHDNR Form (Out-of-Hospital Do Not Resuscitate) is a legal medical directive used to instruct emergency medical services and other out-of-hospital clinicians not to perform cardiopulmonary resuscitation or advanced life support if a patient experiences cardiac or respiratory arrest. It documents a clear, patient-signed instruction that applies outside inpatient settings and should be consistent with state law and local EMS protocols. Properly completed OOHDNR documentation helps ensure patient preferences are honored by field responders, while coordinating with primary care, hospice, and long-term care providers.

Why a properly completed OOHDNR Form matters

A valid OOHDNR Form records patient treatment preferences for out-of-hospital emergencies and reduces clinician uncertainty during critical events.

Who typically completes or signs an OOHDNR Form

Primary users include patients, authorized surrogates, clinicians, and EMS agencies tasked with out-of-hospital care.

Patients with terminal illness or advanced directives who decline resuscitation.
Designated healthcare proxies or legal surrogates when the patient lacks capacity.
Physicians, nurse practitioners, or authorized clinicians who attest to medical appropriateness.

Accurate completion and correct distribution to EMS and care teams are essential to make the form effective in the field.

Step-by-step: completing a Healthcare OOHDNR Form

Follow these steps to complete and distribute the OOHDNR so EMS and other caregivers can follow the patient’s wishes.

01

Confirm capacity: Assess the patient’s decision-making capacity before accepting a directive.
02

Discuss options: Explain what OOHDNR covers, alternatives, and likely outcomes.
03

Obtain signatures: Have patient or authorized surrogate and clinician sign and date the form.
04

Distribute copies: Place copies with caregivers, notify primary clinician, and register with EMS if available.

Where to send the completed OOHDNR Form

The form must be visible to those responding to out-of-hospital crises; route copies to the appropriate recipients below.

Patient and caregiver: Keep a clearly marked original or legal copy at the patient’s residence.
Primary clinician: Add the form to the patient’s medical record for continuity.
Local EMS agency: Submit to the EMS agency or registry per local protocol where available.
Care facility: Provide copies to hospice, skilled nursing, or assisted living staff as applicable.

Configuring an online OOHDNR workflow

Set up an electronic workflow that captures attestations, signatures, and distribution automatically.

Field \| Configuration	Required \| Format/Control
Authentication level	Email + SMS code or stronger for surrogate signing
Clinician attestation	Required signed checkbox and date field
Automated distribution	Auto-send PDF to EMS registry and primary clinician
Audit logging	Capture IP, timestamp, and action history

Digital signing and technical requirements

Ensure the chosen system supports exportable audit reports and secure storage to meet legal and clinical needs.

File formats: PDF and DOCX supported for firm copies
Integrations: EHR, cloud storage, and EMS registry connectors
Authentication: Email, SMS, or multi-factor signer verification

Timelines and renewal expectations for OOHDNR

Time elements affect enforceability and distribution; note these common timing events and obligations.

Effective date entry:

Form is effective on the date signed unless state law specifies otherwise.

Clinician review:

Periodic clinical review may be required by facility policy.

Registrar submission:

Submit to local EMS registry per jurisdictional rules when available.

Form updates:

Update immediately on any change in patient wishes or substitute decision-maker.

Retention requirement:

Keep copies per retention policy and applicable law.

Key security and compliance elements to include

HIPAA controls: BAA required when PHI is stored or transmitted

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Audit trail: Capture IP, timestamp, and signer actions

Access controls: Role-based access and SSO recommended

Retention: Follow regulatory retention timelines

Authentication: Multi-factor options for surrogate signing

Consequences and legal risks of incorrect OOHDNR forms

Form invalidity: May be unenforceable in the field

Unwanted treatment: Patient care may not reflect their wishes

Civil liability: Care providers could face legal claims

Regulatory penalties: HIPAA violations carry fines if PHI mishandled

EMS noncompliance: Local protocols could supersede an incorrect form

Delay in care: Confusion can cause critical response delays

Common mistakes to avoid when preparing an OOHDNR

Using an outdated or out-of-jurisdiction form that EMS does not recognize.
Missing clinician attestation or required witness signatures under local rules.
Storing the form where first responders cannot find it quickly at the scene.
Failing to distribute the form to the primary clinician and local EMS registry when available.

Core components of a professional OOHDNR Form

A complete OOHDNR includes identity, clinical attestation, explicit treatment instructions, signatures, distribution instructions, and legal authority statements.

Patient identity

Full legal name, date of birth, and contact details for reliable matching to records and EMS charts.

Treatment directive

Clear wording that specifies withholding CPR and advanced airway interventions in out-of-hospital cardiac or respiratory arrest scenarios.

Clinician statement

Physician or authorized clinician signature attesting that the OOHDNR is medically appropriate and consistent with the patient’s wishes.

Signature block

Patient or authorized surrogate signature with printed name, relationship, date, and any required attestation of authority.

Witness or notary

Witness signatures or notarization if required by state or local EMS protocol to validate document authenticity.

Distribution instructions

Explicit direction on where copies should be kept and how EMS and care teams should be notified or registered.

Real-world experience with digital medical forms

Organizations using digital signing for clinical directives report easier distribution and auditability for patient instructions.

John Butler, Founder — Fertility Centers of Illinois

Digital signatures and secure workflows simplified document handling across clinics

Improved administrative speed and compliance
The team praised responsive support, the API, and the ability to get signed documents back quickly and securely.

Tim Martin, Founder — Martin Properties

Using digital forms let the organization process documents remotely

Field and office staff could sign on mobile devices
The ability to execute documents online maintained compliance and sped up required authorizations.

Practical tips for accurate and efficient OOHDNR completion

Follow these operational best practices to minimize disputes and ensure EMS can act in accordance with the documented directive.

Use jurisdictional forms

Always use the state- or agency-approved OOHDNR form when available; nonstandard forms may not be recognized by EMS or local registries.

Centralize storage

Keep a prominently labeled copy at the patient’s residence, add it to the EHR, and register with local EMS registries or dispatch systems where possible.

Confirm surrogate authority

When a proxy signs, verify written authority under state law and document the legal basis to avoid later challenges.

Document clinician review

Record the clinician’s attestation, diagnosis context, and any counseling provided so the medical rationale is clear for responders.

Comparing eSignature platforms for OOHDNR workflows

Platform selection affects cost, HIPAA support, bulk distribution, and envelope limits; compare core plan features below without date stamps.

	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	No	No	Yes, limited	Yes, limited
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 OOHDNR Form

Answers to common practical and legal questions help avoid invalid forms and distribution errors.

Need help? Contact support

Can an OOHDNR be created electronically?
Yes. Electronic execution is permissible where state and agency rules allow, subject to ESIGN and UETA standards for intent, consent, attribution, and retention.
Is a clinician signature always required?
Many jurisdictions require clinician attestation that the OOHDNR is medically appropriate; verify local EMS and state requirements to confirm who must sign.
Do I need a notary or witnesses?
Witness and notary requirements vary by state. Some states require witnesses or notarization; confirm with the local health department or legal counsel.
How do I ensure EMS will honor the form?
Register the OOHDNR with local EMS registries when available, distribute copies to first responders, and ensure the form uses accepted wording and clinician attestation.
Can a surrogate sign an OOHDNR?
Yes, when permitted by state law and documented authority; include proxy relationship and legal basis, and confirm authentication to minimize disputes.
How long should I keep the signed form?
Retain the form in the medical record and locally per HIPAA (6 years) and organization policy; consider keeping copies longer for legal defense.

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