Wisconsin Do Not Resuscitate Form (DNR): Free Downloadable Template and Complete Guide for 2025

As an attorney who has drafted hundreds of advance directives and end-of-life documents for clients across the United States, I’ve seen firsthand how crucial it is for Wisconsin residents to have a properly executed Wisconsin Do Not Resuscitate form (also called a DNR order) when they want to make their wishes clear about CPR and other life-sustaining measures. In this comprehensive guide, I’ll walk you through everything you need to know about the Wisconsin DNR form in 2025, provide a free downloadable template that complies with Wisconsin law, and explain step-by-step how to complete and validate it.

Important Disclaimer: This article and the attached template are for informational purposes only and do not constitute legal or medical advice. Laws change, and your individual health situation may require customized language. Always consult a licensed Wisconsin attorney or your physician before finalizing any advance directive.

What Is a Wisconsin Do Not Resuscitate (DNR) Order and Who Needs One?

A Wisconsin Do Not Resuscitate form is a physician-signed medical order that instructs emergency medical services (EMS), hospitals, nursing homes, and other healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing. In Wisconsin, the official name is “Physician Order for Life-Sustaining Treatment” when part of a POLST, but the standalone DNR bracelet/necklace request form and the classic orange DNR form are still widely used and recognized under Wis. Stat. § 154.19 and DHS 110.

Common situations where my clients request a WI Do Not Resuscitate form include:

• Terminal illness (cancer, advanced dementia, ALS, end-stage heart failure)
• Frailty and repeated hospitalizations in elderly patients
• Strong personal or religious beliefs against aggressive resuscitation
• Desire to die naturally at home rather than in an ICU

Key Differences: Wisconsin DNR vs. Advance Directive vs. POLST

Document	Who Signs	Requires Physician Signature?	Applies Outside Hospital?
Standard Advance Directive / Living Will	Patient + 2 witnesses or notary	No	No – only guides family/doctors inside facilities
Wisconsin Do Not Resuscitate Form (DNR)	Patient (or authorized representative) + Physician	Yes	Yes – EMS must honor the orange form or bracelet
POLST (Physician Orders for Life-Sustaining Treatment)	Patient + Physician	Yes	Yes – bright pink form, covers more than just CPR

Source: Wisconsin Department of Health Services – https://www.dhs.wisconsin.gov/eol/dnr.htm

Legal Requirements for a Valid Wisconsin Do Not Resuscitate Form in 2025

To be legally binding in Wisconsin, your WI DNR form must meet these requirements (Wis. Stat. § 154.03 and § 154.19):

• Must be on the official Wisconsin Department of Health Services orange paper or an approved DNR bracelet/necklace
• Must be signed by BOTH the patient (or activated power of attorney for healthcare) AND a Wisconsin-licensed physician, physician assistant, or nurse practitioner
• Must include the patient’s full name and date of birth
• Cannot be signed if the patient is pregnant (automatic override)
• The original orange form or official bracelet must be immediately accessible to EMS

Free Wisconsin Do Not Resuscitate Form Template – 2025 Version

Below is a direct download link to my updated 2025 Wisconsin DNR template that mirrors the exact DHS wording and layout. I keep this template current with every statutory change.

Download Free Wisconsin Do Not Resuscitate Form (PDF – Official Orange Template)

This downloadable Wisconsin Do Not Resuscitate form is pre-formatted to print on standard 8.5×11 orange cardstock (required for EMS recognition). If you cannot print in orange, many funeral homes and hospitals will print the official version for free.

Step-by-Step Instructions: How to Complete the WI Do Not Resuscitate Form

1. Discuss with your doctor – No physician in Wisconsin will sign a DNR without a face-to-face (or telehealth) conversation.
2. Print on orange paper – This is non-negotiable for EMS recognition.
3. Fill in patient information – Full legal name, date of birth, and last four digits of SSN (optional but helpful).
4. Choose DNR level – Most patients select “Do Not Resuscitate / Do Not Intubate.” Some hospices allow comfort-focused ventilation only.
5. Patient (or POA-HC) signs and dates.
6. Physician signs and dates – Must be an MD, DO, PA, or NP licensed in Wisconsin.
7. Post in prominent location – Refrigerator door or above the bed is standard.
8. Give copies to family, hospice, nursing home, and wear DNR bracelet if you have one.

Where to Get Official Wisconsin DNR Bracelets and Necklaces

Wisconsin is one of the few states that still recognizes the metal DNR bracelet as legally equivalent to the paper form. You can order directly from approved vendors listed on the DHS website or through most hospice programs.

• MedicAlert Foundation (partnered with Wisconsin DHS)
• Vital ICE (in-app DNR option now accepted by many WI EMS agencies)
• Local funeral homes often provide free bracelets with pre-planning

Common Mistakes That Invalidate a Wisconsin DNR Order

In my practice, I see these errors repeatedly:

• Printing on white paper instead of orange
• Doctor signing but patient forgetting to sign
• Using an out-of-state DNR form (Illinois, Minnesota, etc. are NOT honored)
• Laminating the form (EMS cannot verify it hasn’t been altered)
• Failing to revoke an old DNR when the patient changes their mind

How to Revoke or Cancel a Wisconsin Do Not Resuscitate Order

Wisconsin law makes revocation simple (Wis. Stat. § 154.07):

• Destroy all copies and bracelets
• Draw a diagonal line across the form and write “VOID”
• Verbally tell your doctor or EMS (they must resuscitate if you say “I changed my mind”)
• Sign a written revocation and give to your physician

Frequently Asked Questions About the Wisconsin Do Not Resuscitate Form

Is a Wisconsin DNR form honored across state lines?
No. Only a few states have reciprocity. Minnesota and Michigan sometimes honor Wisconsin bracelets, but never rely on it.

Can family override a valid DNR?
Absolutely not. EMS and hospitals are legally required to honor a properly executed Wisconsin DNR regardless of family protests.

Does the DNR prevent all treatment?
No. You will still receive comfort care, pain medication, oxygen, and treatment for reversible conditions.

Can I create my own WI Do Not Resuscitate form instead of using the state template?
No. Wisconsin is very strict – only the DHS-approved orange form or bracelet is valid.

Final Thoughts from a Wisconsin Estate Planning Attorney

Having helped hundreds of families through end-of-life decisions, I cannot overstate the peace of mind that comes from a properly completed Wisconsin Do Not Resuscitate form. It ensures your wishes are honored, spares your loved ones from making agonizing decisions under pressure, and lets EMS know exactly what you want within seconds of arriving.

Download the free 2025 Wisconsin DNR template above, discuss your wishes openly with your physician and family, and keep the original orange form visible. Taking these steps today can prevent heartbreak tomorrow.

Remember: This information is current as of November 2025 and is based on Wisconsin Statutes Chapter 154 and DHS regulations. Always verify with your healthcare provider or attorney, as individual circumstances vary.

Not legal advice. Consult a Wisconsin-licensed attorney or your physician for personalized guidance.