Do Not Resuscitate Form: How to Get One and What It Actually Does

One of the most consequential documents in end-of-life planning is also one of the most misunderstood. A Do Not Resuscitate (DNR) order is not a declaration that your parent wants to die — it's a specific medical instruction about one particular intervention: CPR. Understanding what it does, what it doesn't do, and how to actually get one is essential for any family navigating serious illness or end-of-life planning.

What a DNR Actually Means

CPR (cardiopulmonary resuscitation) is a procedure to restart the heart when it stops beating or to restore breathing when it stops. It includes chest compressions, electric shocks (defibrillation), and often emergency medications.

CPR is effective in certain situations — primarily sudden cardiac arrest in otherwise healthy people. For elderly patients with serious illness, frailty, or terminal conditions, the success rate is much lower, and survivors often experience significant complications including broken ribs, brain injury from oxygen deprivation, and extended ICU stays with diminished quality of life.

A DNR order instructs healthcare providers not to perform CPR if your parent's heart stops or they stop breathing. That's the only thing a DNR restricts. It does not mean:

• No pain medication
• No antibiotics or other treatments
• No hospitalization
• No feeding or hydration
• "Do nothing" or give up on the patient

A parent with a DNR can still receive full medical treatment for illness and injury — they've simply decided that CPR is not an intervention they want attempted.

DNR vs. POLST vs. Living Will: What's the Difference?

These three documents often get confused:

Living Will / Advance Directive: A document your parent writes that expresses their general treatment preferences. It's not a medical order — it guides decision-making but doesn't command emergency responders.

DNR Order: A physician-signed medical order that specifically instructs care providers not to attempt CPR. This IS a binding order that emergency responders and hospital staff must follow if the document is present and valid.

POLST (Physician Orders for Life-Sustaining Treatment): A physician-signed order (or set of orders) that covers a broader range of decisions than a DNR alone — including CPR, mechanical ventilation, hospitalization, and artificial nutrition. A POLST essentially translates a patient's advance directive into actionable medical orders.

In practice: if your parent wants a DNR, the most effective implementation is a POLST form with the DNR box checked, signed by their physician. This form travels with the patient and is recognized across care settings (home, hospital, skilled nursing facility, hospice).

How to Get a DNR Form

There is no single national DNR form — the document varies by state and is called different things in different places:

• Most states: DNR Order or DNAR Order (Do Not Attempt Resuscitation)
• California: POLST (replaces standalone DNR for most outpatients)
• New York: DNR Order (hospital-issued) or MOLST (outpatient)
• Texas: OOHDNR (Out-of-Hospital Do Not Resuscitate Order) for use outside hospitals
• Florida: DNRO (Do Not Resuscitate Order) — distinctive yellow form
• Oregon: POLST form

The process to get one:

Step 1: Have the conversation with your parent's doctor. The decision to request a DNR should start with a goals-of-care discussion with the primary care physician or specialist. Ask directly: "Given my parent's current condition, what would CPR likely accomplish? What are the risks?" This conversation helps make the decision clearly, not in a panic.

Step 2: The physician completes and signs the form. Your parent cannot sign a DNR themselves and have it be binding — it requires a physician's signature to become a medical order. The physician will typically assess whether the request is medically appropriate given the patient's condition and prognosis.

Step 3: Your parent (or healthcare proxy) consents. The patient (or their legal healthcare proxy if they lack capacity) must consent to the order. In most states, the physician signs the order and the patient or proxy signs a consent form.

Step 4: The form is placed where it can be found. For home use, the signed DNR or POLST form should be in a visible location — the refrigerator door is the universally recognized standard because paramedics are trained to check there. In a hospital or nursing home, it goes in the patient's medical record.

Florida's Distinctive Yellow Form

Florida is worth a specific note because its DNRO form is bright yellow by design — so it's immediately identifiable by emergency responders. If your parent lives in Florida and has a DNR order, the document must be on the specific Florida DNRO form. Other states' DNR forms are not legally valid as DNR orders in Florida.

The Florida DNRO must be signed by the patient (or surrogate) AND the attending physician. It must be available at the scene for EMS personnel to honor it.

Out-of-Hospital DNR: The Critical Distinction

A DNR order signed in a hospital applies to that hospital stay. If your parent is discharged home and their heart stops, paramedics who respond to a 911 call are legally required to attempt CPR unless there is a valid out-of-hospital DNR in place.

This matters most when:

• Your parent is receiving hospice care at home
• Your parent has moved from a hospital or skilled nursing facility to home care
• Your parent has a terminal condition and wants to avoid aggressive intervention

If your parent has a hospital DNR and goes home, confirm with their doctor whether an out-of-hospital order (or POLST) has been signed. The two are separate documents in many states.

Hospice and the DNR

If your parent is enrolled in hospice care, a DNR is almost universally part of the admission process. Hospice philosophy centers on comfort and natural death — CPR is generally incompatible with those goals. Most hospice programs will discuss DNR preferences at or before enrollment and facilitate the paperwork with the patient's physician.

Importantly, hospice families should know: do not call 911 if your parent is in hospice and has a DNR. Call the hospice nurse instead. Paramedics who respond to a 911 call at a private residence are legally required to attempt resuscitation unless a valid out-of-hospital DNR is physically present and they can see it. The hospice nurse, by contrast, will not attempt CPR and will handle the death appropriately.

This is not a hypothetical scenario — it's one of the most common crises hospice nurses receive calls about. Have the hospice number saved in multiple phones in the household.

Can a DNR Be Reversed?

Yes. A DNR order can be revoked at any time by the patient (or their proxy) as long as the patient has mental capacity. The patient simply tells the medical provider they want to revoke it, and the order is canceled. A patient who regains the desire for full resuscitation can always change course.

This reversibility is worth communicating to parents who are hesitant — choosing a DNR is not an irrevocable step. It reflects their values at this point in their life and can change.

The Conversation You Need to Have First

The hardest part of getting a DNR is not the paperwork — it's the conversation. Most families avoid it because it feels like giving up. But a DNR is not giving up; it's choosing what kind of medical care aligns with your parent's values.

Some questions that can open this conversation:

• "If your heart stopped, would you want doctors to try to restart it? What if the chance of coming home was very low?"
• "What does a 'good death' look like to you? Is being in the hospital on machines part of that picture?"
• "If CPR worked but you had significant brain damage afterward, would you want to be kept alive?"

These are not comfortable questions. They're necessary ones. The End-of-Life Planner workbook includes conversation scripts specifically designed for opening these discussions without creating conflict, along with worksheets to document your parent's answers so nothing is lost when decisions need to be made quickly.

After the DNR Is in Place

Once signed:

• [ ] Post a copy on the refrigerator (visible to any emergency responder)
• [ ] Give a copy to the primary physician for the medical record
• [ ] Give a copy to any specialists, home health aides, or hospice team
• [ ] Note the document's location in your parent's Document Locator
• [ ] If your parent is moving to a new care setting, bring the original and confirm the new facility has entered it in their system
• [ ] Review the decision annually or after any major change in health status