Putting a do-not-resuscitate order in place requires a conversation with your doctor and a signed medical form. It is not something you can do entirely on your own: a physician, nurse practitioner, or physician assistant must sign the order for it to be legally valid. The process is straightforward, but the details vary by state, and there are a few important decisions to make along the way.
What a DNR Actually Covers
A DNR is a medical order that tells hospital staff or emergency responders not to perform CPR if your heart stops or you stop breathing. That’s it. It does not affect any other type of medical care. You will still receive pain management, antibiotics, surgery, or any other treatment you want. A DNR only applies to the specific moment of cardiac or respiratory arrest.
This is narrower than many people assume. If you want to address other decisions, like whether you’d accept a ventilator, a feeding tube, or aggressive treatment for a terminal illness, you need a broader document. A living will covers those preferences in writing. A durable power of attorney for health care (sometimes called a medical power of attorney) names a specific person to make decisions on your behalf if you become unable to communicate. A DNR can be part of these larger advance directives, but it doesn’t replace them.
Steps to Get a DNR Order
Start by talking with your primary care doctor. This conversation covers your current health, your values around end-of-life care, and what CPR realistically offers in your situation. For context, overall survival to hospital discharge after in-hospital CPR is about 17%. That number drops for people with advanced chronic illness: roughly 11% for those with advanced cancer, 10% for those with severe liver disease, and around 15% for those with advanced lung disease. Your doctor can help you weigh these odds against your personal goals.
Once you’ve made your decision, your doctor completes and signs the DNR order. In most states, a physician’s signature is required, though some states also allow nurse practitioners or physician assistants to sign. You or your legal surrogate also sign the form. Some states require a witness signature, while others require notarization for related advance directive documents. Check your state’s specific requirements, as the rules differ.
If you’re currently in a hospital or nursing facility, the DNR is entered directly into your medical record. At facilities using electronic health records, the DNR status populates the header of your chart so every provider on your care team can see it immediately. It also carries over into shift-change handoff tools and internal communications.
Making Your DNR Work Outside the Hospital
A standard hospital DNR order does not automatically apply when you’re at home or in a public setting. For that, you need an out-of-hospital DNR form, which is a separate document designed for emergency medical services personnel. Without it, paramedics arriving at your home are legally required to attempt resuscitation.
The out-of-hospital DNR form must be properly completed and accessible. Many people keep the original posted on their refrigerator or near the front door. In Texas, for example, you can also obtain an official identification bracelet or necklace inscribed with “Texas Do Not Resuscitate” that EMS personnel are trained to recognize and honor in place of the paper form. Other states have similar identification options. The key point: if paramedics can’t find your form or identify your DNR status, they will perform CPR.
POLST Forms: A Broader Option
Many states now use a form called POLST (Physician Orders for Life-Sustaining Treatment). Some states call it MOLST or MOST, but the concept is the same. A POLST is a set of actionable medical orders that covers more ground than a DNR alone. It typically includes your CPR preference in one section, plus separate sections for other interventions like ventilators, IV fluids, and antibiotics.
POLST forms originated in Oregon in the 1990s and are now approved or operational in some form in all 50 states. They’re designed to travel with you between settings: from home to the ambulance to the emergency room to a nursing facility. Like a DNR, a POLST requires a clinician’s signature. If your main concern is CPR but you also have opinions about other life-sustaining treatments, a POLST may be the better document to complete. Your doctor can help you decide which forms make sense for your situation.
Who Can Request a DNR
Any competent adult can request a DNR for themselves. You do not need to be terminally ill or elderly. If you’re able to understand the decision and communicate your wishes, the choice is yours.
If a person is unable to make their own medical decisions, a legally designated surrogate, such as someone named in a durable power of attorney for health care, can request a DNR on their behalf. This can become complicated when family members disagree. If conflict arises between a surrogate and the medical team, hospitals typically involve an ethics consultation to work toward a resolution that respects the patient’s known wishes.
Changing or Revoking a DNR
A DNR stays in effect for as long as you want it to. You can revoke it at any time, and you don’t need a lawyer to do so. In most states, you can simply destroy the physical form and verbally tell your medical team that you want full resuscitation. You should also notify your doctor’s office and your family so everyone is on the same page. If your DNR is recorded in a hospital’s electronic health record, ask your care team to update it.
This flexibility matters. Your preferences may shift as your health changes. A DNR made during a serious illness can be reversed if your condition improves and your outlook on resuscitation changes.
Common Mistakes to Avoid
The biggest practical failure is having a DNR that no one can find when it matters. Keep the original form in a visible, consistent location at home. Give copies to your doctor, your hospital, your surrogate decision-maker, and any facility where you receive care. If you split time between residences, keep a copy at each one.
Another common gap is assuming a hospital DNR covers you everywhere. It does not. If you want your wishes honored at home or in transit, you need the out-of-hospital version and, ideally, a wearable identifier your state recognizes.
Finally, don’t assume your family automatically knows your wishes. A study of patients with POLST documents found a notable rate of discordance, meaning the patient’s stated preferences and what was actually recorded didn’t always match. Talk through your decisions with your surrogate and your family, not just your doctor. The conversation is as important as the paperwork.