Do Not Resuscitate (DNR) Indiana

Document name

Out of Hospital Do Not Resuscitate Declaration

Where do you get the form

You should get the form from your physician or other medical professional.  If you would like a blank form, click here.

 Who is permitted to request a DNR

You can request a DNR if you have a terminal condition or a medical condition such that if you were to suffer a heart attack, resuscitation would be unsuccessful or within a short period of time you would suffer a repeated heart failure.

 Who signs the form

The patient or his healthcare proxy, the patient’s physician and two witnesses must sign the form.

How do you obtain a DNR  bracelet

You can purchase one through MedicAlert or other sellers of the same type of bracelet.

 Revoking a DNR

The patient may revoke the DNR with a signed, dated writing, or by physical cancellation or destruction by the patient.

 State info link

Other link

Special notes

Order a Vial of Life decal for your front door.  The decal informs an Emergency Medical Services team that a DNR has been prepared and can be found in your refrigerator.