The two types of DNR orders are an in-hospital DNR and an out-of-hospital DNR (sometimes called OOH DNR). An in-hospital DNR is placed in your medical chart and applies while you’re a patient in a hospital or care facility. An out-of-hospital DNR travels with you and instructs emergency medical personnel not to perform CPR if your heart or breathing stops at home, in public, or anywhere outside a medical facility.
These two forms exist because a standard hospital DNR order has no legal weight once you leave the building. Without a separate out-of-hospital order, paramedics arriving at your home are required to begin resuscitation efforts regardless of what your hospital chart says.
In-Hospital DNR Orders
An in-hospital DNR is a medical order written by a physician and placed directly in your chart at a hospital, nursing home, or other care facility. It tells the medical team not to perform CPR, which includes chest compressions, cardiac drugs, and placement of a breathing tube, if your heart stops or you stop breathing. The order is specific to CPR. It does not affect other treatments like pain medication, antibiotics, IV fluids, or nutrition. You continue to receive all other care appropriate to your condition.
A DNR can also be part of a hospice care plan, where the focus shifts from prolonging life to managing symptoms like pain and shortness of breath while maintaining comfort. In a hospital setting, the order stays active in your chart for the duration of your stay and can be updated by your physician if your wishes change.
Out-of-Hospital DNR Orders
An out-of-hospital DNR is designed to communicate your wishes to emergency responders, home health aides, and other personnel who would not have access to your hospital medical records. Each state has its own specific form that must be properly completed and signed to be legally valid. In Texas, for example, EMS personnel will only honor an OOH DNR if it’s been executed according to state requirements, or if the person is wearing an approved identification device.
That identification can take the form of a plastic bracelet, a metal bracelet, or a necklace inscribed with the state’s specific DNR language. In Texas, the device must include the words “Texas Do Not Resuscitate – OOH” and can only be obtained after the official order form has been fully completed. These physical identifiers exist for a practical reason: if you experience cardiac arrest at home, paramedics need to verify your DNR status within seconds, not search through paperwork.
Without a valid out-of-hospital form or wearable identifier, EMS personnel are legally obligated to begin CPR, even if family members verbally state the person has a DNR.
DNR Comfort Care vs. DNR Comfort Care-Arrest
Some states further divide DNR orders into two subcategories. Ohio, for instance, distinguishes between “DNR Comfort Care” and “DNR Comfort Care-Arrest,” and the difference is significant.
A DNR Comfort Care order takes effect immediately when it’s issued. From that point on, all treatment is focused on comfort rather than life-prolonging interventions. A DNR Comfort Care-Arrest order, by contrast, only activates when the person actually goes into cardiac or respiratory arrest. Until that moment, the patient may still receive a broader range of medical treatments. This distinction matters because it determines how aggressively your medical team manages other health problems that arise before a cardiac event.
How a DNR Differs From a DNI
People often encounter “DNI” alongside “DNR” and assume they’re the same thing. They’re not. A DNR, or Do Not Resuscitate, means no CPR of any kind: no chest compressions, no cardiac drugs, and no breathing tube. A DNI, or Do Not Intubate, is narrower. It means chest compressions and cardiac drugs may still be used, but no breathing tube will be placed down your throat.
A person might choose a DNI over a full DNR if they’re willing to accept some resuscitation efforts but want to avoid being placed on a mechanical ventilator. The two orders can also be combined, depending on what you discuss with your physician.
How a DNR Relates to a POLST
A POLST (Physician Orders for Life-Sustaining Treatment) is a broader document that includes a DNR option but goes further. While a DNR only addresses CPR, a POLST can also specify your preferences for feeding tubes, mechanical ventilation, hospitalization, and other interventions. POLST forms are portable medical orders, meaning they follow you from hospital to nursing home to your own home to hospice. Emergency medical technicians are trained to honor them.
Not every state uses the term “POLST.” Some call it a MOLST (Medical Orders for Life-Sustaining Treatment) or use other names. But the purpose is the same: a single, portable document that captures a wider range of treatment preferences than a DNR alone.
Why CPR Survival Rates Matter for This Decision
Understanding what CPR actually achieves can help frame the decision. For people 65 and older who experience cardiac arrest outside a hospital, about 32% of those who make it to the hospital alive ultimately survive to discharge, based on data from the American Heart Association’s Cardiac Arrest Registry. That number drops further for people with more chronic health conditions or whose cardiac arrest happens at home without a witness.
Even among survivors, outcomes can be difficult. About 27% of discharged patients die within three months, and roughly half die within three years. During the first year after discharge, 40% are readmitted to the hospital at least once. Factors that improve survival include having someone witness the arrest, receiving bystander CPR quickly, and having an initial heart rhythm that responds to defibrillation. For people with serious chronic illness, these numbers are an important part of deciding whether a DNR aligns with their values and goals.
Revoking a DNR
A DNR is not permanent. You can revoke it at any time by putting your revocation in writing with a signature and date, by physically destroying the document, or simply by telling healthcare providers at the scene that you no longer want the order in effect. No waiting period or legal process is required. If you’re wearing a DNR identification bracelet or necklace, removing and discarding it is part of the revocation. The key point is that you remain in control of this decision for as long as you’re able to communicate your wishes.