Can a DNR be signed electronically?

Electronic signatures may be acceptable when the signing method meets ESIGN (15 U.S.C. ch. 96) and relevant state rules and when the health system's platform supports required authentication and retention. Verify facility policy and state-specific requirements before relying on an electronic-only signature for out-of-hospital enforcement.

Who can sign on the patient's behalf?

A patient with capacity signs their own order. If a patient lacks capacity, a legally authorized surrogate may sign under state law. Clinicians should document surrogate status and authority per facility policy to ensure the order is accepted.

How is a DNR order revoked?

A patient or authorized surrogate can revoke a DNR by clearly communicating revocation to the treating clinician and documenting the change in the medical record; follow facility procedures to notify EMS and other providers of revocation promptly.

What if EMS does not recognize the order?

Recognition of an out-of-hospital DNR depends on state and EMS agency policy. Carry patient-held documentation and ensure transfers include the signed order; contact local EMS medical control for guidance.

How should the form be stored?

Store the signed DNR in the patient's medical record and retain per facility and federal guidance. For electronic records, maintain audit trails, secure storage, and access controls consistent with HIPAA requirements.

When should clinicians reassess the order?

Reassess the DNR at hospital admission, after significant clinical changes, during transfers, and periodically (for example, annually) to confirm it still reflects patient preferences and current clinical circumstances.

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Michigan Do-Not-Resuscitate Order

Michigan Do-Not-Resuscitate Order

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What the Michigan Do-Not-Resuscitate Order Is and When It Applies

The Michigan Do-Not-Resuscitate Order is a clinician-issued medical order that instructs healthcare professionals and responding emergency personnel not to perform cardiopulmonary resuscitation (CPR) if a patient's heart or breathing stops. It documents patient or surrogate preferences about resuscitation and is intended to be placed in the medical record and made available to EMS when state and local policy permit. The DNR order complements advance directives and goals-of-care discussions, providing a clear, actionable instruction at the point of crisis to align care with patient wishes.

Why a Clear DNR Order Matters for Patients and Providers

A Michigan Do-Not-Resuscitate Order provides explicit direction that reduces unwanted resuscitation attempts, aligns clinical actions with patient goals, and minimizes uncertainty among care teams and family members. It supports consistent decision-making across care settings when executed according to facility and state policy.

Who Commonly Completes and Relies on a Michigan DNR Order

Patients, legally authorized surrogates, clinicians, and emergency responders rely on the Michigan Do-Not-Resuscitate Order to record and act on resuscitation preferences during transitions of care.

Patients and surrogates — to document and communicate clear end-of-life resuscitation preferences across healthcare settings.
Hospital clinicians and primary care physicians — to place a definitive medical order in the chart for inpatient and outpatient teams to follow.
EMS and first responders — to recognize and honor the order during out-of-hospital emergencies when state and local protocols permit.

Primary Roles for Creating and Executing a DNR Order

Patient / Surrogate

A patient with decision-making capacity or a legally authorized surrogate conveys preferences about resuscitation. The clinician documents those preferences on the Michigan Do-Not-Resuscitate Order. Surrogates must have authority under state law and be prepared to provide identification or documentation when requested.

Ordering Clinician

A licensed clinician (physician, nurse practitioner, or physician assistant where permitted) assesses capacity, documents clinical rationale, and signs the DNR order to create an actionable medical order within the patient's health record and treatment plan.

Essential Fields and Short Identifiers on the Form

Patient Name: Full legal name as on ID

Date of Birth: Enter as MM/DD/YYYY, verify accuracy

Medical Record Number: Clinic or hospital MRN

Order Date/Time: MM/DD/YYYY and time

Ordering Clinician: Name, license type, signature

Witness/Verifier: Name and staff title or relation

Common Risks and Legal Consequences of an Incorrect DNR Order

Clinical Liability: Failure to follow may risk malpractice

Invalid Order: Missing clinician signature may void order

Emergency Delays: Ambiguous forms can delay care decisions

HIPAA Concerns: Improper disclosure can breach privacy rules

Care Conflicts: Family disputes may complicate adherence

Documentation Gaps: Incomplete fields reduce legal weight

Frequent Errors to Avoid When Preparing the Michigan DNR Order

Using an outdated or nonfacility-approved form can cause nonrecognition by EMS or receiving hospitals during an emergency, resulting in confusion and inconsistent care.
Failing to document a capacity assessment or surrogate authority increases the chance clinicians will hesitate to place or follow a DNR order when urgent decisions are needed.
Including vague or conditional language instead of explicit 'Do Not Resuscitate' wording can create ambiguity for first responders and clinical staff.
Not distributing copies to the patient, chart, and emergency services or failing to document communication reduces the likelihood the order will be available when required.

Step-by-Step: How to Complete and Activate a Michigan DNR Order

Follow this sequence to prepare, sign, and distribute a Michigan Do-Not-Resuscitate Order so it is clear and available when needed by clinicians and EMS.

01

Confirm Identity: Verify patient identity and decision-making capacity.
02

Discuss Goals: Document the patient's wishes and clinical options.
03

Complete Order: Enter required fields and clinical rationale.
04

Distribute Copies: Place in chart, give patient copy, notify EMS.

Key Review Moments and Timing for a Michigan DNR Order

Establish scheduled reviews and trigger-based reassessments to ensure the Michigan Do-Not-Resuscitate Order remains accurate and reflects current wishes and clinical circumstances.

Admission Review:

Review and, if necessary, reconfirm DNR status at hospital or facility admission.

Significant Status Change:

Reassess when the patient's diagnosis, prognosis, or goals of care change significantly.

Annual Review:

Consider an annual review if the patient remains under ongoing care.

Transfer of Care:

Provide a copy to receiving facilities, home health agencies, or EMS during transfers.

Revocation Timing:

Revocation becomes effective when documented and communicated to the care team per facility policy.

Technical Requirements for Digital Completion and eSubmission

Electronic completion and submission require platforms that provide authentication, audit trails, secure storage, and, when applicable, a HIPAA-compliant Business Associate Agreement.

File Formats: PDF and Word DOCX formats supported
Integrations: Integrates with EHRs, Box, Google Drive
Authentication: Email token, SMS code, or MFA

Setting Up an Electronic DNR Workflow

Configure your electronic DNR workflow to capture signatures, verification, and archival metadata in a compliant, auditable manner.

Field	Configuration
E-sign Placement	Place signature, date, and clinician fields near clinical rationale.
Signer Authentication	Use email token or stronger multifactor authentication.
Audit Trail Retention	Keep timestamps, IP, and signer history for at least six years.
Storage Format	Store signed PDF/A in EHR and document management system.

Typical eSignature Pricing Comparisons for Clinical Forms and Orders

Comparing vendor pricing models and compliance features can inform platform selection for electronic DNR workflows; signNow appears first in the table 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 by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Practical Tips to Ensure a Valid and Actionable Michigan DNR Order

Follow these practical best practices to improve clarity, enforceability, and interoperability of DNR orders across clinical teams and settings.

Use Unambiguous Language

State 'Do Not Resuscitate' explicitly and avoid conditional phrasing. Clear phrasing reduces interpretive risk for EMS and inpatient teams and prevents delays during emergencies.

Document Capacity and Authority

Record an assessment of patient capacity and document surrogate authority when applicable. This supports clinicians when orders are questioned and reduces legal uncertainty.

Keep the Order Accessible

Place a signed copy in the medical record, provide the patient or surrogate a copy, and follow facility protocols to notify EMS when transferring to home or another facility.

Review Periodically

Revisit the order after major clinical changes or at least annually. Regular review ensures the order continues to reflect patient goals and current clinical circumstances.

Realistic Use Scenarios for a Michigan DNR Order

These short scenarios show how a properly executed Michigan Do-Not-Resuscitate Order functions in common care situations.

Hospital Inpatient Scenario

A hospitalized patient with advanced illness discussed goals of care and completed a DNR order with their clinician

Order implemented immediately by the care team on the ward
With a clear, signed order on file the patient avoided unwanted CPR, family decisions were aligned with previously stated wishes, and the order accompanied discharge plans to hospice and home health.

Home Hospice Transfer

A terminally ill patient entering home hospice had a clinician place a DNR order in the chart and provided a copy to the hospice nurse

EMS were given documented instructions at transfer
During a subsequent out-of-hospital event the presence of a completed DNR order prevented cardiopulmonary resuscitation inconsistent with the patient's documented wishes.

Frequently Asked Questions About the Michigan Do-Not-Resuscitate Order

Answers to common questions address validity, electronic signing, revocation, signature authority, and storage to help clinicians and patients manage DNR orders effectively.

Need help? Contact support

Can a DNR be signed electronically?
Electronic signatures may be acceptable when the signing method meets ESIGN (15 U.S.C. ch. 96) and relevant state rules and when the health system's platform supports required authentication and retention. Verify facility policy and state-specific requirements before relying on an electronic-only signature for out-of-hospital enforcement.
Who can sign on the patient's behalf?
A patient with capacity signs their own order. If a patient lacks capacity, a legally authorized surrogate may sign under state law. Clinicians should document surrogate status and authority per facility policy to ensure the order is accepted.
How is a DNR order revoked?
A patient or authorized surrogate can revoke a DNR by clearly communicating revocation to the treating clinician and documenting the change in the medical record; follow facility procedures to notify EMS and other providers of revocation promptly.
What if EMS does not recognize the order?
Recognition of an out-of-hospital DNR depends on state and EMS agency policy. Carry patient-held documentation and ensure transfers include the signed order; contact local EMS medical control for guidance.
How should the form be stored?
Store the signed DNR in the patient's medical record and retain per facility and federal guidance. For electronic records, maintain audit trails, secure storage, and access controls consistent with HIPAA requirements.
When should clinicians reassess the order?
Reassess the DNR at hospital admission, after significant clinical changes, during transfers, and periodically (for example, annually) to confirm it still reflects patient preferences and current clinical circumstances.

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