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Do Not Resuscitate: Do DNR Forms Need to be Notarized?

A DNR, or a Do Not Resuscitate form, is a key component of an advance directive. Learn the rules around creating and notarizing a DNR here.

Patrick Hicks

Patrick Hicks, @PatrickHicks

Head of Legal, Trust & Will

People often think that Do Not Resuscitate forms are only used by the terminally ill or elderly. Unfortunately, end-of-life scenarios can strike anyone, at any age. Although we might not want to think about it, it’s important to let medical providers know if you don’t want certain medical interventions. Here, we provide some clarifications on the DNR form. By the end of this guide, you’ll know what the DNR form is used for, what makes it valid, and whether or not you need to have it notarized. 

What is a Do Not Resuscitate Form?

A Do Not Resuscitate Form, or DNR Form for short, is a type of advance directive that tells medical providers that you do not want to be resuscitated in certain conditions. Although they are optional, DNR forms are often used by individuals who are in poor health, such as when they have a terminal illness or have organ failure. These patients may feel that resuscitation would only prolong a death that is inevitable, and may bring them back in worse conditions.

A DNR form goes into effect when a patient becomes incapacitated. When they are unable to communicate their own wishes, hospital staff and other medical care providers are legally required to abide by what is stated on the DNR form. (You can find Do Not Resuscitate Laws by state.)

The form typically describes how extensive of a medical intervention the patient wants, and what procedures they refuse. 

Check out this in-depth definition of DNR for more information.

What Makes a DNR Valid?

A DNR form must meet certain requirements in order for it to be valid. DNR laws vary from state to state, but the requirements are generally similar. You may also see some variation based on the type of DNR form that is used. 

The two common types of DNR forms are the in-hospital DNR form and the out-of-hospital DNR form. The first is the traditional DNR that is used at a hospital or other medical facility. An out-of-hospital DNR, or prehospital DNR, is used for anyone who does not want to be resuscitated if the medical event happens outside of the facility, such as in their home, in public, or during transport.

Here are the requirements of two example DNR forms.

The first is an out-of-hospital DNR form issued by the Texas Department of Health, in compliance with Chapter 166 of the Texas Health & Safety Code. The form requires the full name of the patient (printed or typed), along with their gender and date of birth.

Next, the patient refuses resuscitation measures by providing their signature and date. However, this signature can be replaced by a qualified agent if the patient is incapacitated. This could be their legal guardian, Medical Power of Attorney agent, or qualified relative.  Once the patient or agent signs the form, it must also be signed by two witnesses. At least one of these two witnesses cannot be an employee of the hospital or attending physician to maintain neutrality. Finally, the attending physician must sign off on the form.

In the case that the patient is incapacitated but does not have an agent present, two physicians can sign off on the DNR form instead. They may be attesting to the patient’s verbal request for DNR, or they are in agreement that medical interventions would not be helpful or effective for this particular patient.

The second example is a prehospital DNR form issued by the California Emergency Medical Services Authority. This particular form would be provided by medical staff in the case of an emergency, such as when there is a house call or the patient is being transported to the hospital in an ambulance. This form also requires the patient’s full printed legal name, plus their signature and date to refuse any resuscitation efforts. A legally recognized agent can also sign in the patient’s place. Finally, the attending physician must sign the form verifying that it has been legally signed by the patient or their health care agent. Witness signatures are not required on this particular form, likely due to its designation for emergency purposes. 

In summary, the minimum requirement in order for a DNR form to be valid is the valid signature and date of the patient, or of their legally recognized healthcare agent in the event that they are incapacitated or otherwise unable to express their wishes. Second, the form must be signed off by the attending physician. Depending on the state and the type of form used, witness signatures may also be required. This brings us to the question of whether or not a DNR form needs to be notarized. 

Do DNR Forms Need to be Notarized?

Most DNR forms do not need to be notarized, although they can be. Typically, two adult witnesses are required to watch you sign the order, and then add their own signatures to attest that you were sound of mind. However, you can replace these two witness signatures by having your DNR Form signed by a notary. 

Again, the legal requirements for the validity of a DNR form can vary by state, and there are also some variations based on the type of form used. Be sure to find out the requirements in your state.

Can Anyone Sign a DNR?

Not just anyone can sign a DNR; each state has legal requirements in order for a DNR to be valid. In most cases, a DNR must be signed by the patient and the attending physician. In the case that the patient is incapacitated, the DNR can be signed by their legally authorized health care agent. Some states also require that the DNR is signed by two adult witnesses or a notary public.

How to Set Up a DNR

There is a common misconception that do not resuscitate orders are best used by older adults and the elderly. However, end-of-life circumstances can strike us at any age. Planning ahead is the key to protecting yourself and demanding the medical care you want. Further, making your wishes known can relieve loved ones of having to make difficult medical decisions on your behalf.

A DNR form can be incorporated in your Advance Directive documents. You can use these documents to write down your medical care wishes, and use a Medical Power of Attorney to designate your health care agent. This is an especially important step. In the examples we presented above, you may have noticed that your legal health care agent can sign a DNR form on your behalf. This could make a huge difference in an emergency medical situation. 

Not sure how to get started? Trust & Will makes it easy for you to set up your Advance Directive and other health care documents in a few simple steps. When you complete the process, you’ll have your HIPAA Authorization, Living Will, Powerful Attorney, and your Last Will & Testament. All of your medical bases will be covered. Find out how to create your healthcare documents here

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