Tip for DNR (state-specific)

A hospital DNR order does NOT apply outside the hospital — you need an out-of-hospital DNR for home or transport

Tip for DNR (state-specific)

A DNR only addresses CPR — it does NOT limit other treatments (medications, surgery, dialysis, etc.)

Tip for DNR (state-specific)

You can revoke a DNR at any time by telling your physician

Advance PlanningeasyDoctor signature required

Do Not Resuscitate (DNR) Order

DNR (state-specific) · State Departments of Health

Medical order directing healthcare providers not to perform CPR if the patient's heart stops or they stop breathing. Cannot be created by the patient alone; requires physician signature. Comfort care always continues.

Form Details

Total fields: 18
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Filled by: both
Frequency: one time
State-specific: Yes — form may vary by state

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Where to Submit This Form

🏢

Physician completes and signs the order in the patient's medical record

A DNR order is a physician order — the patient requests it, but the physician must issue it.

Filing Deadline

Can be issued at any time when requested by a patient with decision-making capacity (or authorized representative). Effective immediately upon signing.

Required Attachments

📎 Physician signature on the DNR order
📎 Patient or authorized representative informed consent documentation
📎 Facility-specific DNR order form (for inpatient settings)

Processing Time

Immediate. The DNR order is effective as soon as the physician signs it in the medical record.

What Happens Next

The order is placed in the patient's medical chart. Nursing staff and code teams are notified. For hospitalized patients, a DNR bracelet or indicator may be placed. This order applies only within the facility unless accompanied by an out-of-hospital DNR.

Tips for This Form

✓ A hospital DNR order does NOT apply outside the hospital — you need an out-of-hospital DNR for home or transport
✓ A DNR only addresses CPR — it does NOT limit other treatments (medications, surgery, dialysis, etc.)
✓ You can revoke a DNR at any time by telling your physician
✓ Discuss with family so they understand your wishes and do not request CPR against the order

More Advance Planning Forms

Advance Directive / Living Will

State-specific · State Law (forms from AARP, state bar associations, hospitals)

Legal document specifying medical treatment preferences when the individual is unable to make decisions. Requirements for witnesses and notarization vary by state. Free state-specific forms available from AARP and state agencies.

Living Will (State-Specific)

Varies by state · State Legislatures / State Bar Associations

Written declaration of preferences regarding life-sustaining treatment, artificial nutrition and hydration, and comfort care when terminally ill or permanently unconscious. Legally distinct from healthcare proxy in many states.

Healthcare Power of Attorney / Healthcare Proxy

State-specific · State Law

Designates a trusted person (agent/proxy) to make healthcare decisions when the individual cannot. May be part of a combined advance directive or a separate document depending on state law.

POLST (Physician Orders for Life-Sustaining Treatment)

POLST · State Health Departments (46 states as of 2026)

Medical order (not just a directive) specifying life-sustaining treatment preferences. Actionable by EMS. For patients with serious life-limiting illness or advanced frailty. Works alongside advance directives.

MOLST (Medical Orders for Life-Sustaining Treatment)

MOLST · State Health Departments (e.g., New York)

New York's version of POLST. The only authorized form in NY for documenting non-hospital DNR and DNI orders. Must be completed by a physician in consultation with the patient or surrogate.

MOST / POST / COLST (State Variants)

MOST / POST / COLST · Various State Health Departments

State-specific variants of POLST: Medical Orders for Scope of Treatment (MOST), Physician Orders for Scope of Treatment (POST), Clinician Orders for Life-Sustaining Treatment (COLST). Functionally equivalent to POLST.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Departments of Health or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.