Do Not Resuscitate (DNR) Order Template

What Is a Do Not Resuscitate Order?

A DNR Order is a legally binding medical directive that instructs healthcare providers to withhold cardiopulmonary resuscitation and other life-sustaining interventions. Unlike broader advance directives, a DNR form is a specific, actionable order that first responders and hospital staff can follow immediately without consulting family members or interpreting your general wishes.

This do not resuscitate form template covers conditional and unconditional options, specifies which treatments to withhold versus allow, and includes all required witness and notarization sections. It integrates with your existing healthcare power of attorney or advance directive to create comprehensive end-of-life documentation.

 

Is This DNR Order Template Right for You?

You need this template if you're:

• Managing a terminal illness and planning end-of-life care
• Elderly and want to prevent unwanted aggressive interventions
• Updating your estate plan with comprehensive healthcare directives
• Recovering from a serious medical event and reassessing priorities
• A caregiver helping a loved one document their wishes

You definitely need this template if:

• Your family members disagree about what you would want
• You've experienced medical trauma and fear losing bodily autonomy
• You want to prevent CPR that could leave you with diminished quality of life
• Your current healthcare directives don't include specific resuscitation instructions

 

 

Why Thousands Trust Legal GPS Templates

Save Money. Attorney-quality protection without $500+ legal fees.

Save Time. Complete your DNR Order in under 30 minutes.

Look Professional. Comprehensive formatting that healthcare providers recognize.

Keeps You Out of Court. Clear provisions in the Scope of Order and Healthcare Agent Authorization sections prevent family disputes and ensure your documented wishes are honored without litigation.

 

 

Get Protected in 3 Simple Steps

Step 1: Secure Checkout. Purchase through our encrypted payment system with instant confirmation.

Step 2: Instant Download. Receive your DNR Order template immediately in your email inbox.

Step 3: Fill In the Highlighted Fields. Follow the included how-to guide to customize every section for your specific situation, then have it witnessed and notarized.

 

Frequently Asked Questions

Can I use this template multiple times?

Yes. Once purchased, you can use the template for yourself and modify it as your circumstances change. Many people update their DNR Order annually or after significant health changes.

Is this contract legally binding?

Yes, when properly executed with required witnesses and notarization per your state's requirements. The template includes guidance on state-specific execution requirements to ensure validity.

Does a DNR Order mean I won't receive any medical care?

No. A DNR specifically addresses resuscitation after cardiac or respiratory arrest. You'll continue to receive all other medical care, including comfort measures, pain management, and treatments for your underlying conditions.

Can I change my mind after signing a DNR Order?

Absolutely. You can revoke your DNR Order at any time by destroying the document, writing a revocation, or simply telling your healthcare provider. The template includes a complete section on your revocation rights.

Do I need a lawyer to complete this DNR Order?

No. This template is designed for self-completion with our comprehensive how-to guide. However, if you have complex medical or family situations, consulting an elder law attorney can provide additional peace of mind.

Will hospitals and EMS honor my DNR Order?

Healthcare providers are legally obligated to honor valid DNR Orders. The template includes distribution guidance and an EMS verification section to ensure your wishes are accessible and actionable in emergency situations.