Free Template

Do Not Resuscitate (DNR) Form

2 signers
1 Patient
2 Witness
Use this template

Secure Your Medical Wishes with an Editable DNR Form Template

Do not resuscitate (DNR) forms are crucial legal documents that express your desires regarding medical treatment in the event of a life-threatening emergency. They give you more control over your end-of-life care, ensuring that your wishes are respected. Our free, editable DNR form template at Fill is an essential resource to guide you through the process.

do not resuscitate dnr order form template
Navigating the complexities of DNR forms can be overwhelming. Different states or countries have their own requirements, and there may be specific signing procedures, such as notary publics or witnesses. With this template, you can confidently create a personalized and compliant DNR form tailored to your needs.
By choosing Fill’s DNR form template, you gain access to a comprehensive and customizable resource. Our template is designed to be user-friendly, providing clear guidance for patients, healthcare agents, and medical professionals. Secure your medical decisions with Fill today.

The Purpose of a Do Not Resuscitate Order Form

Whether you’re a West Virginia patient, New Mexico patient or Michigan patient, you deserve the peace of mind that comes with a properly executed DNR form, knowing that your end-of-life care preferences will be respected and followed by your health care providers. FillHQ’s comprehensive template can help you achieve this, regardless of your location.

  • Clarifying Patient Wishes – A DNR order form is a legal document that explicitly states a patient’s desire not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatments in case of cardiac or respiratory arrest. These orders ensure that patient’s wishes are followed, allowing them to pass away naturally without undergoing aggressive medical interventions.
  • Guiding Health Care Professionals – DNR order forms provide clear instructions to health care professionals, medical staff, and emergency medical services (EMS) personnel, reducing confusion and potential legal complications. By having a properly executed DNR form, doctors and first responders can make informed decisions based on the patient’s preferences, focusing on palliative care and pain management instead.

Use Cases of a Do Not Resuscitate Form

When considering your end-of-life options, it’s essential to weigh the benefits and drawbacks of various medical treatments. A natural death, free from aggressive interventions, may be preferable for some individuals.

By completing a DNR form, you can express your desire to forgo certain medical care, such as CPR treatment, in specific situations. Granting medical power to a trusted healthcare agent ensures that your wishes are upheld, even when you’re unable to communicate them personally. Ultimately, a well-prepared DNR form allows you to take control of your medical journey, focusing on the quality of your remaining time and your personal values.

  • Terminally Ill Patients – Individuals who are terminally ill and have a limited life expectancy may choose to complete a DNR form. This ensures that their end-of-life care is in line with their values, allowing for a more peaceful and dignified passing.
  • Patients with Chronic Conditions – Some patients with chronic conditions, such as advanced heart disease or lung disease, may choose to forgo aggressive resuscitation measures, as these treatments may not significantly improve their quality of life. A DNR form can clearly communicate their preferences to their healthcare provider or team.

Comprehensive and Customizable

Our DNR template covers a wide range of patient scenarios and state requirements. It includes specific signing requirements for witnesses, notary publics, and health care professionals, ensuring your DNR form is legally valid.

Easy to Use

Fill’s template is designed with user-friendliness in mind. The editable form is straightforward and easy to complete, allowing you to create your personalized DNR form with confidence.

Informative and Accurate

Our DNR template provides detailed guidance on how to properly execute your form based on your state’s regulations. This helps ensure that your DNR form is accurate and legally binding.

Accessible and Free

This DNR template is available free of charge. We believe everyone should have access to quality legal resources to make informed medical decisions.

FAQ About DNR Forms

A DNR order is a specific medical order that focuses on whether or not to provide CPR and life-sustaining treatments in case of an emergency. A living will is a broader legal document that outlines a person’s general preferences for end-of-life care, including life-sustaining treatment, organ donation, and other medical decisions. While a living will may mention a DNR preference, it is recommended to have a separate, specific DNR order form to ensure clear communication with medical professionals.
In most cases, a valid and properly executed DNR order cannot be overridden by family members. The order represents the patient’s wishes and is intended to guide medical professionals in their treatment decisions. However, if there is a dispute or if the family has new information that may change the patient’s wishes, they should consult with the patient’s health care team and legal professionals to resolve the issue.
Yes, a DNR order can be revoked by the patient at any time, as long as they are of sound mind and able to communicate their decision. The revocation should be documented in the patient’s medical records and communicated to their health care providers. In some cases, a new DNR form may need to be completed if the patient’s wishes change.
While many states recognize out-of-state DNR orders, some may have additional requirements or different forms. It is important to consult with your health care provider or legal professional if you move to a new state or plan to receive medical treatment in another state. They can help ensure your DNR order is valid and recognized according to state laws.

" Undoubtedly one of the best eSignature application available in the market right now. Would love to recommend Fill. "

Liam Washington

Ready to get started
with this template?

Click the button below to add this template to your account. If you do not have an account, you can sign up for a free trial to start using this template.