Michigan Do Not Resuscitate Order (DNR) Form

The Michigan DNR form is a legal document that an individual makes for the purposes of denying any resuscitation help from the medical staff in cases when he or she may need one.

This form is usually filled out by people with some severe health conditions, in which there would not be any use gained from a CPR procedure.
In other cases, when the person is perfectly fine or does not have any serious illnesses, the DNR form should not be filled. Doing so would only harm the patient’s life in the future, as the doctors would not have any right to restore the heartbeat or breathing of an individual.

According to MCL §333.1053 law, for this document to become legally powered, it should be signed not only by the patient but also by their physician and two other witnesses. Before deciding on making this printable DNR form, please consult with your physician or religious leader, as they may have some additional information about your concrete condition.

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Download your fillable Michigan DNR form in PDF format.

How to Fill out the Michigan DNR Form

Your preparatory step would be to download the DNR form or print it for further filling out, which is only logical.

Also, you will see that the first two pages of the document are only for you and your future medical staff to get acquainted with, so you may read it or skip straight to the third page, where the filling out process starts.

Please follow the steps that are described by us further:

1. The first paragraph requires you, as the patient, to fill in the full name of your physician, the one who will also sign this Michigan DNR form.
step 1 to filling out the michigan dnr form

2. The second paragraph will require your signature, the signature of your representative if this is the case and the signature of the physician whose name was written down before.
step 2 to filling out the michigan dnr form

3. Also, each of the names should be put down as well. The lines after each of the signatures are made for that purpose.

step 3 to filling out the michigan dnr form

4. Moreover, the three of you should fill in the date when the document was signed next to each of the signatures.
step 4 to filling out the michigan dnr form

5. When all of the steps above are done, proceed to the next section related to the witnesses. Here, each of them should write down their signature, full name, and the date of signing the form.
step 5 to filling out the michigan dnr form

Another way that this DNR form can be filled out requires a religious representative. If that is your case, please do not forget about the fourth page of the document.

  • Here, the declarant and his or her representative (if present) should put down the signatures, the full names, and the date of signing the document.

step 6 to filling out the michigan dnr form

  • The two witnesses’ signatures, names, and the signing date should also be written down on this page.

step 7 to filling out the michigan dnr form

When all of the previous steps are done, simply give the document to your physician to put it in your medical record.

Published: Oct 18, 2021