A California DNR order is a written request regarding resuscitative measures, signed by the patient or a legally recognized health care decisionmaker and by the patient's physician. It tells health care providers what to do if the patient's heart stops or the patient stops breathing.[1] The form states that it does not prevent other emergency medical care. You can create a California DNR form on FormsPal in a few minutes or download the PDF.
Last Updated: October 2026. This guide is reviewed and updated regularly to reflect current California law. If you notice an error or outdated information, please contact us.
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The California DNR form tells emergency medical services (EMS) personnel not to restart a patient's heart or breathing. If the patient has cardiac or respiratory arrest, the form says these measures are not to be started:
The form says it does not affect life-sustaining measures such as artificial nutrition or hydration. It also leaves other emergency medical care in place, such as treatment for pain, shortness of breath, or major bleeding.
The form's own text says it was designed for use outside acute care hospitals, for example in a patient's home or a long-term care facility. FormsPal also has a general DNR form page for other states, and a California living will for other health care wishes.
In California, a DNR order is a request regarding resuscitative measures under the Health Care Decisions Law in the Probate Code. It is a written document, signed by an individual with capacity or a legally recognized health care decisionmaker, and by the individual's physician.[1]
A printed form substantially similar to the one described in Section 4780 is valid and enforceable when all three of these conditions are met:
The statute puts the printed-form rule this way:
A printed form substantially similar to that described in subparagraph (A) of paragraph (2) of subdivision (a) of Section 4780 is valid and enforceable if all of the following conditions are met: (1) The form is signed by the individual, or the individual’s legally recognized health care decisionmaker, and a physician. (2) The form directs health care providers regarding resuscitative measures. (3) The form contains all other information required by this section.
Section 4780(a)(2)(A) recognizes the prehospital do not resuscitate form developed by the Emergency Medical Services Authority or another substantially similar form.[1]
The instructions are on page 1 of the California DNR form, and the part you fill in is on page 2. Create the form online with our builder, or download the PDF and complete it with our online PDF editor. You can also print the form and fill it in by hand.
The screenshots under each step show the FormsPal California DNR order template filled with sample entries in blue, so you can see where each answer goes. The names, addresses, dates and amounts are examples only.
Then complete the rest of page 2 in this order.
Signature, date and relationship. The patient signs on the first line and writes the date. If the patient cannot sign, the legally recognized health care decisionmaker signs and dates the form. That person also writes their relationship to the patient on the line below.
Physician section. The physician signs and dates the form, prints their name, and adds a telephone number.
Copies. The form comes in three copies, as listed in its footer:
The form's instructions say the completed form needs to be readily available to EMS personnel. They also say the patient may revoke the directive at any time by destroying the form and removing any DNR medallions.
A California DNR order is a written request regarding resuscitative measures under the Probate Code. The answers below cover what the law requires, which sections apply, and whether a signed order can be revoked.
A DNR order must be a written document signed by an individual with capacity, or a legally recognized health care decisionmaker, and by the individual's physician. A health care provider completes the form based on the patient's preferences and medical indications.[1]
DNR orders fall under Sections 4780 to 4786 of the California Probate Code, which are part of the Health Care Decisions Law. Section 4783(b) sets the conditions for a valid printed form.[1][2]
Yes. An individual with capacity may revoke the request at any time and in any manner that communicates an intent to revoke.[1]
General information, not legal or tax advice.
Unless noted otherwise, the sources below are from the California Probate Code, published by the California Legislative Information.
