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Free Do Not Resuscitate (DNR) Form

A do-not-resuscitate (DNR) form helps you share your care preferences with doctors and loved ones. Answer a few questions with Legal Templates' form to create a DNR that meets state requirements.

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  • Takes 4 minutes
  • PDF & Word

How It Works

  1. 1
    Provide Patient Information
    Answer a few quick questions about the person the DNR covers.
  2. 2
    Submit Physician Details
    Include the doctor’s name and contact details so the form is complete.
  3. 3
    Download Your Document
    Download and print your custom DNR form for free.
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  • Sara Hostelley
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    Sara Hostelley
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    Sara Hostelley
    Sara Hostelley is a legal content editor with a bachelor’s degree in English from the University of South Florida. She has over five years of experience crafting informative content across industries, including career, legal, and business sectors, with a focus on making complex topics more accessible to users.
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    Harvey Barbee, J.D.
    Harvey Barbee, J.D.
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    Harvey Barbee, J.D.
    Harvey Barbee is an attorney with 15 years of legal experience in family law, criminal law, personal injury, and civil litigation. He graduated with a bachelor's degree in political science and a juris doctor from the University of North Carolina School of Law. He's an active member of the North Carolina State Bar, North Carolina Bar Association, and Greensboro Bar Association.
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Last Updated October 28, 2025

What Is a Do Not Resuscitate (DNR) Form?

A do-not-resuscitate form is a medical order that tells healthcare staff not to perform CPR if your heart or breathing stops.

  • A DNR form allows for a natural death while still providing comfort care, such as pain relief, oxygen, and medication.
  • Without a DNR form, medical staff must attempt resuscitation even if it goes against your wishes.

Every hospital in the US is required to ask and document whether a patient has a DNR order or an advance directive. You usually discuss it with your doctor and sign it during admission. Once signed, it becomes part of your medical record, ensuring all staff understand and respect your decision.

Some people choose to carry portable DNRs instead of standard DNR papers so their wishes are clear outside a hospital setting. These can include:

  • Bracelets or necklaces that alert emergency responders.
  • Wallet cards that list your DNR status and key contacts.

Having a DNR in place helps you stay in control of your care, especially if you live with a serious or terminal condition. It tells medical professionals and loved ones exactly what you want in an emergency. We offer a free do-not-resuscitate form that you can download and complete. It’s a simple way to document your wishes and share them with your doctor, family, or care team.

Living Will vs. DNR

A DNR only applies to CPR and resuscitation. It can also be part of a larger plan, such as a living will, which covers more medical choices, including life support, feeding tubes, organ donation, and comfort care.

When You May Need a DNR Form

A do-not-resuscitate form is a personal decision about your care in a medical emergency. It’s not only for people facing serious illness. Some choose it to avoid invasive treatments that could affect comfort or quality of life.

Others make the decision based on age, health, or faith. The right time depends on your situation, but here are a few moments when it may make sense to consider one.

Consider a DNR If…What to Keep in Mind
You're living with a terminal or painful conditionA DNR helps prevent unnecessary suffering. You'll still receive comfort care, including pain relief and medication.
You're older, or recovery would be difficultCPR can be intense and physically hard to recover from. Many seniors choose a DNR to focus on comfort and dignity.
Your faith or values guide your medical choicesMost religions are tolerable of DNR ordersif resuscitation is futile. Take time to think about how your beliefs shape your end-of-life decisions.

A DNR is just one part of planning ahead for your health and future. Many people include it when getting their estate plan in order or organizing essential end-of-life documents to keep everything consistent and easy to access.

Make Sure Your Care Team Understands Your DNR

Studies show that medical professionals may interpret DNR orders differently or apply them too broadly. These gaps can affect your treatment.

A Wolters Kluwer report in the American Journal of Nursing found that confusion about DNR orders can lead to uneven care. Talk with your care team to make sure everyone understands your wishes.

How Do I Get a DNR Form?

You can get a do-not-resuscitate form from a few places. The most common option is your doctor or hospital, where staff can help you complete the form and make sure it meets state rules. You can also download a printable DNR form from your state’s Department of Health website.

If you prefer to handle it yourself, use a free do-not-resuscitate form from Legal Templates. It’s quick to download, easy to fill out, and ready to print. Before it’s valid, make sure it includes:

  • A doctor’s signature confirming your choice
  • Witness or notary signatures, if required by your state

Once signed, keep copies in safe, visible places. That could be at home, with your doctor, and with family or caregivers.

How to Write a Do Not Resuscitate Order

Filling out a do-not-resuscitate order makes it clear that you want to withhold resuscitation if you experience cardiac or respiratory arrest. The process is simple but important to get right. Legal Templates has you fill out a few simple details about your situation, and we include a clear statement about your desire to withhold resuscitation.

Start by entering:

  • Your full legal name and any details about a legal representative, if someone can make decisions for you, such as your medical power of attorney.

Then add:

  • Your doctor’s name and contact information so medical staff can confirm the order if needed.

Finish by including:

  • Your state, the date, and all required signatures, such as your doctor’s and any witnesses or a notary.

Once everything’s signed, your DNR form becomes official and part of your medical records, ensuring your wishes are always respected.

How to Revoke a DNR

You can change or cancel a DNR order anytime, even in an emergency. Start by telling your doctor so they can remove it from your medical record. Some states may ask for a short written request.

Then, take these steps to make sure no one follows outdated instructions:

Finally, let your family, caregivers, and healthcare providers know about the change. Sharing your updated documents makes sure everyone follows your current wishes.

Laws and Signing Requirements by State

A DNR must usually be signed by a doctor in the same state where it will be used. If you move to another state, you’ll need a new DNR signed by a local physician to keep it valid. Because each state has its own rules, the table below outlines the signing and witness requirements where you live.

State Who Needs to Sign? Legal Code
Alabama Patient and Physician AL Code § 420-5-19-.02
Alaska Patient and either a Witness, Notary Public, or Physician AK Stat 13.52.150
Arizona Patient, Physician, and Witness AZ Rev Stat § 36-3251
Arkansas Patient and either a Notary Public or 2 Witnesses AR Code § 20-13-901
California Patient and Primary Physician CA Prob Code § 4780
Colorado Patient and Attending Physician CO Rev Stat § 15-18.6-103
Connecticut Patient and Physician CT Gen Stat § 19a-580d
Delaware Patient and 2 Witnesses 16 DE Code § 2505
Florida Patient and Primary Physician FL Stat § 401.45
Georgia Patient and Attending Physician GA Code § 31-39.6.1
Hawaii Patient and Attending Physician HI Rev Stat § 327K-2
Idaho Patient and Physician ID Code § 39-4514
Illinois Patient and Witness 755 ILCS 40/65
Indiana Patient, Physician, and 2 Witnesses IN Code § 16-36-5
Iowa Physician IA Code § 144A.7A
Kansas Patient and Witness KS Stat § 65-4943
Kentucky Patient and Primary Physician KY Rev Stat § 311.6225
Louisiana Patient and 2 Witnesses LA Rev Stat § 40:1151.2
Maine Patient and 2 Witnesses ME Rev Stat § 5-805
Maryland Patient and Physician MD Health-Gen Code § 5-608.1
Massachusetts Patient and Physician None
Michigan Patient, Attending Physician, and 2 Witnesses MI Comp Laws § 333.1053
Minnesota Patient and either a Notary Public or 2 Witnesses MN Stat Chapter 145C
Mississippi Patient and Physician MS Code § 41-41-302
Missouri Patient and Attending Physician MO Rev Stat § 190.600
Montana Patient and 2 Witnesses MT Code § 50-9-103
Nebraska Patient and either a Notary Public or 2 Witnesses NE Code § 20-404
Nevada Patient and Attending Physician NV Rev Stat § 450B.520
New Hampshire Patient and Attending Physician NH Rev Stat § 137-J:26
New Jersey Patient and Attending Physician NJ Admin Code § 10:48B
New Mexico Patient and Physician NM Stat § 7.27.6.8
New York Patient and Physician NY Public Health Article 29-B
North Carolina Patient, a Notary Public, and 2 Witnesses NC Gen Stat § 90-321
North Dakota Patient and either a Notary Public or 2 Witnesses ND Cent Code § 23-06.5
Ohio Patient and Physician OH Admin Code § 3701-62
Oklahoma Patient, Physician, and 2 Witnesses OK Stat § 63-3131.5
Oregon Patient and 2 Witnesses OR Rev Stat § 127.810
Pennsylvania Patient and Attending Physician PA Con Stat Title 20 § 5484
Rhode Island Patient and 2 Witnesses RI Gen Laws § 23-4.11
South Carolina Patient and Physician SC Code § 44-78-10
South Dakota Patient and Attending Physician SD Admin Rules § 44:05:06
Tennessee Patient and Physician TN Code § 68-11-224
Texas Patient and either a Notary Public or 2 Witnesses TX HSC Chapter 166
Utah Patient and Physician UT Admin Code § R432-31
Vermont Patient and Physician VT Stat Title 18 Chapter 231
Virginia Patient and Physician VA Code § 54.1-2987.1
Washington Patient and 2 Witnesses WA Rev Code § 70.245
West Virginia Patient and Physician WV Code § 16-30
Wisconsin Patient and Physician WI Stat § 154.17
Wyoming Patient and Physician WY Stat § 35-22-501

Sample DNR Form​

You can view a sample DNR form to see what details it includes before filling out your own. Each printable DNR form shows where to add your information, doctor’s details, and signatures. Once you’re ready, download the DNR form in PDF or Word format and complete it according to your state’s rules.

This is a document preview. Your customized version will be created after you answer a few quick questions.
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Free Do Not Resuscitate (DNR) Form