Michigan Do Not Resuscitate Order
This document serves as a Do Not Resuscitate (DNR) Order in accordance with the laws of the State of Michigan. This order indicates that the individual named below does not wish to receive cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest or cessation of breathing.
Please fill out the information requested below:
- Patient Name: ______________________________________
- Date of Birth: ______________________________________
- Patient Address: ______________________________________
- City: _________________________________________
- State: ______________________ Zip Code: ____________
The following individuals must also sign this DNR Order:
- Signature of Patient (or Authorized Representative): ____________________________
- Date: ______________________________
- Signature of Witness: ______________________________________
- Date: ______________________________
This DNR order will guide emergency medical services and healthcare providers. It is crucial that this document is easily accessible, especially in emergency situations.
For further clarification of state laws regarding DNR orders, please consult with your healthcare provider or legal advisor.