Using Miscellaneous DNI Forms documents patient preferences clearly, reduces clinician uncertainty in emergencies, and creates a reproducible record for care teams and surrogates. When completed correctly they support enforceability, help align care with patient goals, and integrate with advance care planning.
Typical users who complete or rely on these forms include clinicians, hospital staff, and patient representatives across care settings.
Institutions and legal teams also use the forms for policy, compliance review, and continuity of care documentation.
Coordinates form distribution, verifies patient identity, ensures orders match clinical status, and files the completed DNI form in the medical record. Also trains staff on documentation standards and confirms signatures and witness requirements when state law mandates.
Assists patients and surrogates in understanding options, facilitates consent discussions, helps complete paperwork accurately, and ensures copies are provided to appropriate providers. May coordinate with legal counsel when complex capacity or surrogate disputes arise.
Explicit clinical language stating that intubation is refused, defining scope (for example respiratory arrest) and listing any treatments to withhold or permit. Avoid ambiguous phrasing to reduce interpretation differences among clinicians.
Patient or proxy signature with date, and provider signature including printed name and license number. Include witness or notary sections if state law or facility policy requires them.
Designate legally authorized representative with contact information and attach documentation of authority, such as power of attorney or guardianship order, when applicable to reduce disputes.
Include precise dates and times for orders, amendments, and reviews. Timestamping supports clinical interpretation and legal timelines for challenges or audits.
Include form version or revision date and ensure superseded versions are archived. Prevent multiple competing directives by clearly marking the active form.
Designate distribution path: EMR entry, physical copy on chart, patient-held copy, and EMS notification. Clear routing reduces missed notices in emergencies.
| Field | Configuration |
|---|---|
| Authentication | Email link plus SMS two-factor optional for higher assurance. |
| Required Fields | Make signatures, clinical order, and witness fields mandatory. |
| Signer Order | Patient or proxy sign before provider order when policy requires. |
| Retention | Automated export to secure archive with audit metadata preserved. |
Platforms should support secure e-signing, HIPAA controls, and seamless EMR integration for clinical validity in workflows.
Use MM/DD/YYYY; determines when orders take effect.
Enter clinical order immediately in the EMR upon signing.
Provide copies to on-call teams and EMS without delay.
Reassess and document DNI status whenever clinical condition changes.
Record amendments with date, reason, and new signatures.
Discuss preferences and document preliminary intent with patient or proxy.
Provider records clinical DNI order in EMR and signs.
Distribute copies to inpatient, outpatient, and EMS teams.
Store final record in secure archive with audit metadata retained.
| 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 | Yes, 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 |
| Envelope Cap | No envelope cap | 100 envelopes/user/year | Varies by plan | Varies by plan | Varies by plan |
Onward Medical Center adopted a standardized DNI template in the EMR to record patient choices during admission, preoperative evaluation, and care transitions.
A regional EMS agency recognized patient-carried DNI forms improved prehospital adherence to patient wishes and trained crews to look for standardized, prominently labeled documents.