Do Not Resuscitate (DNR) Pennsylvania

Document name

Out-of-hospital DNR order

Where do you get the form

You can only get the form from the patient’s attending physician.

Who is permitted to request an out-of-hospital DNR order for themselves

Only a person who has an end-stage medical condition who is competent and 18 years of age or older or, if under 18 years if age, has graduated from high school, has been married or emancipated, may requests this order for himself or herself.

Who signs the form

The physician and the patient, or the patient’s surrogate, must sign the form.

How do you obtain a DNR bracelet

The bracelet or a DNR necklace can only be secured from the attending physician.  He or she will purchase it from the Health Department’s vendor and then either sell or give it to the patient.

Revoking a DNR

Revocation may be accomplished by destroying or not displaying the order, bracelet or necklace, or by conveying the decision to revoke the out-of-hospital DNR order to an EMS provider verbally or otherwise prior to the time the person experiences respiratory or cardiac arrest.


Pennsylvania statutes do not indicate whether a photocopy is legal or not.

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.