To get a Do Not Resuscitate card, start with a conversation with your doctor, who writes the medical order, signs your state’s out-of-hospital DNR form, and can point you to an approved vendor for a wallet card, bracelet, or necklace that emergency responders will recognize. The form itself is free through your doctor’s office or your state department of health; the wearable ID usually costs extra and is your expense.
The Steps From Start to Finished Card
The process has a few moving parts, but none of them are complicated.
- Talk to your doctor. Schedule a conversation about your wishes. Your provider should walk you through the likely outcomes of CPR given your specific health situation and help you make an informed decision. The doctor needs to understand your reasoning before signing the order.1Merck Manual Consumer Version. Do-Not-Resuscitate (DNR) Orders
- Get the form. Your doctor’s office or hospital usually has blank DNR forms. You can also download your state’s official form from your state department of health website. These forms are free.2MedlinePlus. Do-Not-Resuscitate Order
- Fill it out. The form generally requires your full legal name, date of birth, and address, along with your doctor’s information. Your doctor can fill out most of it for you.
- Sign it. You (or your surrogate) and your doctor both sign. Some states also require one or two adult witnesses or notarization. Notary fees typically run $2 to $15 if notarization is needed.3Merck Manuals. Do-Not-Resuscitate (DNR) Orders and Portable Medical Orders
- Get your card or wearable ID. After the form is fully executed, ask your doctor about a wallet card, bracelet, or necklace. These identification devices may cost extra, and the expense is typically yours. Your doctor’s office should point you to approved vendors in your state.2MedlinePlus. Do-Not-Resuscitate Order
- Add it to your medical record. Your doctor writes the DNR order into your chart. In a hospital or nursing home, this happens immediately. For outpatient care, the signed form becomes part of your file at your doctor’s office.
Ask for the Out-of-Hospital Version, Not the Chart Note
This is where most people get tripped up. A standard hospital DNR goes into your medical chart and is followed by the doctors and nurses treating you inside that facility. If you collapse at home or in a grocery store and someone calls 911, paramedics are legally required to perform CPR unless they see valid documentation telling them otherwise. A hospital DNR sitting in your medical record does nothing for you in that situation.
An out-of-hospital DNR is a separate form designed specifically for emergency responders in the field. Most states require a distinct, brightly colored form that EMS personnel can quickly identify. Completing standard advance directives does not address resuscitation in out-of-hospital settings on its own.4American College of Emergency Physicians. Do Not Attempt Resuscitation Orders in the Out-of-Hospital Setting
The wallet card, bracelet, or necklace is the portable proof of that out-of-hospital order. Design varies by state, but the purpose is the same: giving EMS personnel something they can verify on the spot without digging through paperwork.3Merck Manuals. Do-Not-Resuscitate (DNR) Orders and Portable Medical Orders If EMS arrives and your wishes are unknown, or there is any doubt about the validity of your documentation, they will resuscitate. That default protects people, but it means your DNR card needs to be visible and unambiguous.4American College of Emergency Physicians. Do Not Attempt Resuscitation Orders in the Out-of-Hospital Setting
Who Can Request One
Any competent adult can ask their doctor to write a DNR. You do not have to be terminally ill, though the conversation usually comes up in the context of serious illness, advanced age, or a condition where successful resuscitation is unlikely. If you are near the end of life, your doctor should discuss CPR options with you as part of care planning.2MedlinePlus. Do-Not-Resuscitate Order
If you lack capacity to make medical decisions, someone else can request one for you: a healthcare agent you named, a legal guardian, or in some circumstances a close family member. The surrogate steps in only when you genuinely cannot communicate your wishes.1Merck Manual Consumer Version. Do-Not-Resuscitate (DNR) Orders
A doctor cannot refuse to honor your request simply because they disagree with it. A provider with a moral or professional objection is expected to transfer your care to someone who will carry out your wishes.2MedlinePlus. Do-Not-Resuscitate Order
One point worth understanding before you sign: a DNR is not a “do not treat” order. You still receive pain medication, surgery, antibiotics, oxygen, and every other form of care your condition calls for. The order takes effect only if your heart or breathing stops entirely.
Keeping the Card Usable When It Matters
A DNR card only protects you if the right people can find it at the right time. Keep it on your person whenever you leave the house. A wallet card does no good in a desk drawer. A bracelet or necklace that stays visible is even more reliable, since paramedics are trained to check for medical identification jewelry.
At home, keep the original out-of-hospital DNR form somewhere emergency responders can quickly find it. The refrigerator door is a common recommendation because EMS crews in many areas are trained to check there. Near the front door or at the bedside are other practical spots.
Tell your family, your healthcare agent, and every doctor who treats you that you have a DNR in place and where the documents are. Not a one-time conversation. If you are admitted to a new facility or start seeing a new provider, bring it up again.
Changing Your Mind
You can cancel your DNR at any time, for any reason. The right to change your mind is absolute and does not require justification. If you decide you want CPR after all, tell your doctor immediately.2MedlinePlus. Do-Not-Resuscitate Order
Verbally expressing your wish to revoke is generally enough to start the process, but do not stop there. Your doctor needs to remove the order from your medical record, and you or your caregivers should destroy every physical copy of the form, wallet card, bracelet, or necklace. Any leftover identification could cause confusion during an emergency, especially if you are transferred between facilities where staff may not know the order was cancelled.
If your healthcare agent or guardian established the DNR on your behalf, they can revoke it too, though they typically must do so in writing and notify your attending physician. If you want to adjust the scope of treatment rather than eliminate the DNR entirely, the standard approach is to revoke the current order, destroy the associated documents, and have your doctor write a new one reflecting your updated preferences.
When a DNR Alone Is Not Enough
A DNR covers one question: should CPR be performed? It does not replace a living will, which spells out preferences across a range of situations like ventilators or feeding tubes. You can have both, and in most cases you should.
If you want a single portable document that addresses more than CPR, ask your doctor about a POLST (called MOLST in some states), which stands for Portable Orders for Life-Sustaining Treatment. Nearly every state now has some version.5National POLST Collaborative. Portable Medical Orders A POLST is also a medical order signed by your doctor, so EMS must follow it. It typically covers CPR preferences, the level of medical intervention you want if you are critically ill but your heart is still beating, antibiotics for life-threatening infection, and artificial nutrition. It is designed for people with serious illness or advanced frailty. If your concerns go beyond CPR, a POLST is the better tool, and your doctor can help you decide which document fits your situation.