Where should I keep / post the DNR?

Most EMS look first on the refrigerator. Post the DNR prominently there, plus inside the front door, at the bedside, and provide copies to all treating clinicians, the hospital, hospice, primary care physician, and any long-term-care facility. Some states have a state DNR registry; register if available. The patient or family should also carry a copy when traveling or going to medical appointments.

Will my DNR be honored if I travel to another state?

Generally — most states recognize out-of-state DNR orders under reciprocity rules, but specific provisions may vary. POLST forms (California, Oregon, Massachusetts, etc.) are widely respected. If you spend significant time in another state, complete that state's form too. EMS in some states are required to honor only their own state's form, with exceptions for emergencies.

Who can revoke the DNR?

The patient can revoke at any time, by oral or written notice or by physically destroying the document. The patient's healthcare agent under a valid advance directive can revoke if the patient lacks capacity. Court orders can revoke or override in disputed circumstances. Once revoked, notify all treating physicians, EMS providers (if relevant), and any facility holding a copy.

Can my family override the DNR?

Generally no. A DNR signed by a competent patient is binding; family disagreement does not override patient wishes. If the patient lacks capacity at the time of arrest and the DNR was signed by a properly authorized surrogate (healthcare agent), that surrogate's decision controls. Family disagreement at the moment of arrest is one of the most painful clinical scenarios; advance discussion and clear documentation reduce the likelihood.

Do Not Resuscitate (DNR) Order — State-Specific

Physician-signed DNR order recognized by emergency responders — distinct from living will, required to prevent CPR in emergencies.

Customise

Effective date

Patient — full legal name

Patient — date of birth

Patient — address

Patient — phone

Medical condition / diagnosis

DNR scope

Comfort measures explicitly included

Physician — name

Physician — state license #

Physician — phone

Physician — practice / facility

Witness — name (1, if required)

State (governing law)

Mandatory review date

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DO NOT RESUSCITATE (DNR) ORDER
STATE OF SOUTH CAROLINA

THIS IS A PHYSICIAN-SIGNED MEDICAL ORDER

This Do Not Resuscitate (DNR) Order is a physician-signed medical order that takes effect immediately. It is intended to be honored by all emergency medical services (EMS) personnel, paramedics, hospital and nursing-facility staff, hospice providers, and any other healthcare professional who encounters the patient. This order is NOT a living will or advance directive — it is an actionable medical order.

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PATIENT INFORMATION
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Name:               Margaret L. Hutchinson
Date of Birth:      August 12, 1955
Address:            2418 Riverbend Lane, Charleston, SC 29412
Phone:              +1 843 555 0184

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MEDICAL CONDITION
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Stage IV pancreatic adenocarcinoma, metastatic to liver and lung. Currently on home hospice. Anticipated life expectancy under 6 months. Patient has decision-making capacity at the time of signing.

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DNR ORDER
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COMPREHENSIVE DO NOT RESUSCITATE: No CPR, no intubation, no mechanical ventilation, no defibrillation, no advanced cardiac life support. Comfort care only. This is a comprehensive end-of-life directive.

This Order applies in the following settings:
  ✓ Patient's home or residence
  ✓ Hospital or hospital emergency department
  ✓ Skilled nursing or assisted-living facility
  ✓ Ambulance and emergency-vehicle transport
  ✓ Hospice and palliative-care setting
  ✓ Any other location where the patient receives medical care

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COMFORT MEASURES (EXPRESSLY INCLUDED — PROVIDE ALL)
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Continue all comfort care: pain medication, oxygen for comfort, suctioning, repositioning, mouth care, and any other measure that improves comfort without intent to prolong life.
Provide emotional and spiritual support as requested.
Allow family presence at all times during medical care.

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PATIENT / SURROGATE CONSENT
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I, the patient named above (or the patient's authorized healthcare surrogate / agent under signed advance directive), consent to this Do Not Resuscitate Order. I understand that:

  - In the event of cardiac or respiratory arrest, no resuscitative measures will be initiated as specified in the scope above;
  - This order takes effect immediately and continues until revoked or until the next mandatory review date;
  - I (or my surrogate) may revoke this order at any time by oral or written notice to the physician or by physically destroying this document;
  - This order does NOT prevent the provision of comfort care or non-resuscitative medical treatment.


_______________________________            _______________________________
Patient signature                            Date

(or)

_______________________________            _______________________________
Surrogate / Agent signature                  Date
Name: David S. Hutchinson (son and healthcare agent)
Authority: Healthcare agent under advance directive dated _________

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PHYSICIAN ORDER AND CERTIFICATION
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I, the physician named below, certify that:

  1. I have personally examined the patient and have determined that this DNR order is medically appropriate;
  2. The patient (or the patient's authorized surrogate) has been informed of the nature and consequences of this order;
  3. The patient (or surrogate) has voluntarily consented to this order;
  4. The patient has decision-making capacity (or, if not, the surrogate is properly authorized);
  5. This order is consistent with the patient's known wishes and applicable state law.

Physician Name:        Dr. Helen S. Park, MD
State License #:       SC-12847
State of Licensure:    South Carolina
Phone:                 +1 843 555 0156
Practice / Facility:   Lowcountry Hospice and Palliative Care, Charleston, SC

Physician Signature:   _______________________________
Date:                  May 7, 2026

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WITNESS (where required by South Carolina law)
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Name (print): David S. Hutchinson (son and healthcare agent)

Signature:    _______________________________
Date:         _______________________________

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MANDATORY REVIEW
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This DNR Order must be reviewed at least every 6 months, and updated when:
  - The patient regains decision-making capacity and wishes to change the order;
  - The patient's medical condition changes materially;
  - The patient transfers to a new facility (most facilities require their own DNR form);
  - The physician of record changes.

Next mandatory review date: November 7, 2026

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DISTRIBUTION AND POSTING
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POST THIS ORDER prominently in the patient's residence:
  - On the front of the refrigerator (most common posting location for EMS to find);
  - At the front entrance / inside the front door;
  - On the wall above the patient's bed.

PROVIDE COPIES to:
  - Patient and patient's healthcare agent
  - Patient's primary care physician
  - All current treating physicians
  - Hospital(s) where patient receives care
  - Hospice or palliative-care provider
  - Long-term-care facility (if applicable)
  - State DNR/POLST registry (where available)

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REVOCATION
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This order may be revoked at any time by:
  (a) The patient (if competent), in writing, orally, or by physical destruction of this document;
  (b) The patient's healthcare agent under a valid advance directive;
  (c) Court order.

Upon revocation, the patient or surrogate must notify treating physicians, EMS providers, and any facility holding a copy.

About this template

A DNR order is a physician-signed medical order — categorically different from a living will or advance directive. The distinction matters in emergencies: paramedics and EMS responders are trained to provide CPR by default, and they cannot legally honor a living will alone. They CAN honor a state-recognized DNR order. Without a DNR, a hospice patient who arrests at home will likely receive CPR from responding EMS — directly contrary to their wishes — because EMS cannot stop and verify a living will mid-resuscitation. State DNR forms are highly variable. Some states use a single statewide form (Massachusetts MOLST, California POLST, Pennsylvania POLST, Oregon POLST); other states have multiple forms (in-hospital, out-of-hospital, comfort-care DNR). The POLST/MOLST family of orders is increasingly the standard — typically a colorful (often bright pink, green, or purple) form designed for high visibility, signed by physician AND patient, and recognized across care settings. For DNR orders to work, they MUST: (1) be signed by a licensed physician (typically) — some states accept advanced practice nurses or physician assistants; (2) be signed by the patient or authorized surrogate; (3) be POSTED visibly where EMS will find it (refrigerator, bedside, front entrance); (4) be COPIED to all providers (hospital, hospice, primary care, etc.); (5) be REVIEWED on a regular schedule (typically every 6 months); (6) match state-specific format/coloring requirements. Common failure modes: (a) DNR posted only in nursing home record but not at home — patient at home, EMS provides CPR; (b) Out-of-state DNR not recognized by EMS in current state of residence; (c) Old DNR replaced by new physician but old DNR still on refrigerator — confusing situation; (d) DNR scope limited to "no CPR" but patient also doesn't want intubation — gap addressed only by comprehensive scope. State considerations: California and Oregon POLST forms are widely respected nationally; Massachusetts MOLST has been the model for many other states; Texas, Florida, and Pennsylvania each have specific in-state requirements; some states (Wisconsin, others) have specific registry requirements. Hospice patients usually have DNR as part of admission. Surrogate decision-making: when patient lacks capacity, the healthcare agent under a valid advance directive can request DNR; the physician must agree based on medical appropriateness. Revocation: oral or written notification to treating physician; physical destruction of document. Children: pediatric DNRs are highly state-specific and typically require both parents and physician sign-off. Mental health: DNRs for patients with serious mental illness face additional procedural protections in some states.

When to use it

Hospice or terminal-illness patients (almost always required as part of hospice admission).
Severe chronic illness with limited prognosis (advanced heart failure, COPD, dementia, end-stage renal disease).
Frail elderly patients who choose comfort over intervention.
After patient has expressed clear preferences and physician confirms medical appropriateness.
Some states require DNR as part of long-term-care or skilled-nursing admission for end-of-life patients.

What to include

Patient identification (name, DOB, address, phone).
Brief medical condition / diagnosis statement.
DNR scope (comprehensive vs. CPR-only vs. limited).
Comfort measures explicitly included.
Patient or surrogate consent.
Physician name, license, signature, and date.
Witness (where required by state).
Mandatory review date (typically 6 months out).

Frequently asked

A living will is a STATEMENT of preferences; a DNR is an actionable physician's ORDER. EMS and most emergency clinicians will provide CPR by default; they cannot legally honor a living will mid-resuscitation. They CAN honor a state-recognized DNR order. Without a DNR, a patient who clearly does not want CPR may receive it anyway in an emergency.

⚠ Legal disclaimer. DNR orders are governed by state-specific laws and forms. Many states use POLST/MOLST orders that combine multiple end-of-life directives in a single form. Witness, signature, and posting requirements vary. EMS recognition of out-of-state DNRs varies. A DNR should be coordinated with a comprehensive advance directive and a designated healthcare agent. For pediatric DNRs, mental health DNRs, or DNRs in unusual circumstances, consult the patient's physician and state-specific resources. Not medical advice.