Free Michigan DNR Form

Michigan DNR Form Signing Requirements

Under Section 333.1053 of the Mich. Comp. Laws, a Michigan DNR order must be dated and executed voluntarily, which means made of your own free will. It must also be signed by each person the law lists, which means the declarant (the person the order is for), the declarant's attending physician, and two witnesses.^[1.1]

The law sets these signing rules:

• One signature must come from the declarant, the declarant's patient advocate, or another person who is in the declarant's presence and acting on the declarant's directions at the time of signing.^[1.1]
• The declarant's attending physician must also sign the order, so the physician needs to see the completed form.^[1.2]
• Two witnesses who are 18 years of age or older must sign the order as well, after the declarant and the physician.^[1.2]

The law words the witness rule this way:

Two witnesses 18 years of age or older, at least 1 of whom is not the declarant's spouse, parent, child, grandchild, sibling, or presumptive heir.

In plain words, both witnesses must be adults, and at least one of them must be someone outside that list of relatives. A presumptive heir is a person who is expected to inherit from the declarant.

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How to Fill Out the Michigan DNR Form

Fill out the Michigan DNR form in five steps that follow the order of the form itself. Start with your physician's name on page 3, then collect the signatures, dates and printed names, and finish with the witness block. The form has two signing versions, where page 3 is the standard one and page 4 is for people who belong to a church or religious denomination.

Download the Michigan DNR form PDF and fill it in with our online PDF editor, or print it and complete it by hand. The first two pages explain the order to you and your medical staff, so you can read them or go straight to page 3, where the filling starts.

The screenshots under each step show the FormsPal Michigan 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.

1. Name your physician. On page 3, write your physician's full name on the line in the first paragraph, because this is the physician who will also sign the order as the attending physician.

   

2. Sign, date and print names (page 3). The declarant signs first, then the person signing for the declarant if there is one, and then the physician, and each person dates the signature and prints a name on the line beside it.

   

3. Complete the witness block (page 3). Mark whether the declarant has or has not received an identification bracelet, and then ask each witness to sign, date and print a name on the lines provided.

   

4. Use page 4 if you belong to a church or religious denomination. This is the second signing version, where you sign, date and print the declarant's name. The page also has a block for the person signing on the declarant's behalf.

   

5. Complete the witness block (page 4). Mark the identification bracelet statement, and then each of the two witnesses signs, dates and prints a name.

   

When every step is done, you or your patient advocate keep the signed order and have it accessible at home or in another setting outside a hospital (Section 333.1053(5)). The attending physician who signs the order must immediately get a copy and make it part of your permanent medical record (Section 333.1058).^[2.1]

Tips for Signing the Michigan DNR Form

A DNR form is easier to sign correctly when everyone is ready before the pen comes out. Gather the declarant, the attending physician and both witnesses in one place, confirm that each witness is at least 18 years old, and keep the blank form on hand so nobody has to guess which line belongs to them. These habits are general practice and not a legal requirement.

• Read the whole form with the declarant, so the person understands what the order says and what it changes before signing it.
• Check that at least one witness is outside the group of relatives and heirs named in the law.
• Print each name the same way it appears on the declarant's other medical records, which avoids confusion later.
• Use dark ink and write inside the lines, which keeps photocopies of the order readable for the care team.
• Make copies of the signed order for the family, and ask the physician whether the care team keeps one on file.

Frequently Asked Questions

These short answers cover the two questions people ask most about the Michigan DNR form, and each one points back to Section 333.1053 of the Mich. Comp. Laws, so you can compare the answer with the wording of the law itself before you sign anything.

What is required for a DNR order in Michigan?

The order must be dated and signed by the declarant, the declarant's attending physician, and two witnesses who are 18 years of age or older. At least one witness must not be the declarant's spouse, parent, child, grandchild, sibling, or presumptive heir.^[1.2]

What does Michigan law say about do-not-resuscitate orders?

Section 333.1053 of the Mich. Comp. Laws says who signs a Michigan DNR order. It also says the order must be dated and executed voluntarily.^[1.1]

General information, not legal or tax advice.

Sources

1. Michigan Compiled Laws 333.1053.
   • 1.1 MCL 333.1053
   • 1.2 MCL 333.1053 (witnesses and physician)
2. Michigan Do-Not-Resuscitate Procedure Act, MCL 333.1051 to 333.1067
   • 2.1 MCL 333.1053(5) and 333.1058

Mara Erlach

Writer & Attorney

Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.