Pennsylvania Do Not Resuscitate Order (DNR) Form

Do not resuscitate form (or DNS form) in Pennsylvania works just as DNR forms in other states. It allows an individual to refuse life-saving treatments if a person experiences some serious medical condition. Do not resuscitate form should be signed by both patient and the attending physician, failure to which it would be invalid. When the DNR form is signed and the patient stops breathing due to a medical condition, medics will not intertwine; instead, they would let the person die naturally. Usually, patients tend to request this DNR form if their condition is already terminal and there are no chances of successful treatment.

You will find the precise legal requirements for the DNR forms in Pennsylvania in laws § 5481 – § 5488, where it is described that emergency services of the state of Pennsylvania should not proceed to resuscitate a patient who explicitly denied the possibility of resuscitation by signing a DNR form.

Moreover, it is specified that patients, in order to notify the emergency health services, can wear a sign that says that they should not be resuscitated. The sign is issued by the physician and can be in a few forms:

  • as a necklace
  • as a bracelet

The status of out-of-hospital do-not-resuscitate can be given to a person who is older than 18 years and is in terminal medical conditions or unconscious. In the latter case, the DNR form can be signed by a member of the family or another person acting on behalf of the patient.

How to Fill Out the Pennsylvania DNR Form

To fill out the Pennsylvania DNR form, you do not have to be an experienced lawyer; you just have to pay attention and not make silly mistakes, and our guide will help you avoid them.

Step 1. At the start of filling the DNR form, you have to write the name and surname of the patient. Specifically,  in the first available field on the top of the page.

step 1 to filling out the pennsylvania dnr form

Step 2. Now, look at Section 2A and find the word “printed.” In the space after this word, you have to write the name of the physician; remember that physician should not sign the document before the patient does.

step 2 to filling out the pennsylvania dnr form

Step 3. Now, you have to enter the physician’s telephone number and indicate whether the patient chose to wear a bracelet in the respective field below.

step 3 to filling out the pennsylvania dnr form

Step 4. This section should be filled only if the patient is a pregnant woman. If yes, you have to write the physician’s name for the second time, and they also have to sign the document.

step 4 to filling out the pennsylvania dnr form

Step 5. The next section (3A) is signed only if the patient can sign the DNR form by themselves. If yes, they have to put the signature in the respective field and indicate the date. If the patient is unable to sign the form, it can be done by the surrogate in the section 3B.

step 5 to filling out the pennsylvania dnr form

Step 6. At the end, when all the spaces are filled out and when the patient or surrogate signs the document, the physician has to come back to Section 2A, sign the document, and write the date.

step 6 to filling out the pennsylvania dnr form

Published: Oct 18, 2021