[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-307200-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-307200-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","emergency-care-do-not-resuscitate-order-dnr-instructions","Emergency Care - Do Not Resuscitate Order (DNR) - Instructions","","Wisconsin Department of Health Services form F-44763 (09/2026) provides instructions for completing a Do Not Resuscitate (DNR) order used to request a DNR bracelet. It explains that only the DNR bracelet identifies the patient’s DNR status, outlines emergency care that will be provided versus not provided, and sets requirements for patient/legal guardian authorization. Background sections define CPR and eligibility under Wis. Stat. § 154, Subchapter III.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/emergency-care-do-not-resuscitate-order-dnr-instructions/307200/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/emergency-care-do-not-resuscitate-order-dnr-instructions/307200.png","ImageObject",442,249,{"name":42,"@type":43},"Alex Sinclair","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-24","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What identifies a patient as DNR in an emergency?","Question",{"text":63,"@type":64},"Only the Do Not Resuscitate (DNR) bracelet identifies that the patient is DNR.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What emergency treatments will personnel provide under this DNR order?",{"text":68,"@type":64},"Emergency personnel will provide a clear airway, oxygen, comfort positioning, splinting, bleeding control, pain medication, emotional support, and contact hospice or home health if involved.",{"name":70,"@type":61,"acceptedAnswer":71},"What does the DNR order prohibit in an emergency?",{"text":72,"@type":64},"Emergency personnel will not perform chest compressions, insert advanced airways, administer cardiac resuscitation drugs, provide ventilator assistance, or defibrillate.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},307200,1790122661,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":22},1099523882182,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Department of Health Services State of Wisconsin  \nDivision of Public Health Wis. Stat. § 154  \nF-44763 (09/2026) Page 1 of 3  \nEmergency Care  \nDo Not Resuscitate Order (DNR)  \nInstructions  \nOnly the Do Not Resuscitate (DNR) bracelet identifies that you are DNR. This form is a legal document and is used to request a DNR bracelet by the attending health care professional on the patient’s behalf. Please seepage two and three of this form for instructions and background information.  \nThe patient and the legal guardian or health care agent of an incapacitated patient have the right to revoke these restrictions on care at any time.  \nEmergency medical service or emergency health care facility personnel, as appropriate, will provide:  \n• Clear airway.  \n• Administer oxygen.  \n• Position for comfort.  \n• Splint.  \n• Control bleeding.  \n• Provide pain medication.  \n• Provide emotional support.  \n• Contact hospice or home health agency if either has been involved in patient’s care, or patients attending health care professional.  \nEmergency medical service or emergency health care facility personnel will NOT:  \n• Perform chest compressions.  \n• Insert advanced airways.  \n• Administer cardiac resuscitation drugs.  \n• Provide ventilator assistance.  \n• Defibrillate.  \n Male  Female  \nPrint patient name:   Date of birth:   Patient’s address:   City:   State:   ZIP Code:    \nI / patient, legal guardian or health care agent understand this document identifies the level of care to be rendered to the patient by an emergency medical service or emergency health care facility personnel in situations where death may be imminent. I / patient, legal guardian or health care agent make this request knowingly and am aware of the alternatives as explained to by the attending health care professional. I / patient, legal guardian or health care agent expressly release all persons who will in the future provide medical care of any and all liability whatsoever for acting in accordance with this request. I / patient, legal guardian or health care agent is aware that this order can be revoked at any time by removing or defacing the identification bracelet or by requesting resuscitation.  \nSignature—Patient or legal guardian or health care agent of an incapacitate patient (Circle title of who is signing this request):  \nDate signed:    \nPrint name of attending health care professional:   Phone number:    \nSignature—Attending health care professional:   Date signed:    \nPlease note that the previous signatures and dates are required for this order to be valid and its intent carried out. Please do not mail your DNR orders to the Wisconsin Department of Health Services, Division of Public Health. You should keep a copy for your own records and a copy should be in your medical files at your primary care physician’s office.  \nBackground Information and instructions for completing Do Not Resuscitate Order (DNR)  \nBackground information  \nCardiopulmonary resuscitation (CPR) is a procedure used after cardiac arrest in which cardiac massage, drugs, and artificial ventilation are used to restore breathing and circulation. It is standard medical practice to perform CPR on all persons found to be in cardiac or respiratory arrest in the absence of directives from an attending health care professional to withhold such action. However, patients may legally and ethically decline these treatments. The DNR order is used to implement the decision that CPR is not to be performed. This decision to limit CPR rests with the attending health care professional and his/her qualified patient, legal guardian, or health care agent as described in Chapter 154, Subchapter III of the Wisconsin Statutes. A qualified patient means a person who is at least 18 years old and to whom any of the following conditions applies:  \n• The person has a terminal medical condition.  \n• The person has a medical condition that if the person were to suffer cardiac or pulmonary failure, resuscitation would ","cbCairMbnR18iX3Q","https://ap.wps.com/l/cbCairMbnR18iX3Q","pdf",234058,"English","# Emergency Care Do Not Resuscitate Order (DNR) Instructions\n## Scope, bracelet requirement, and revocation rights\n## Emergency care that will be provided vs not provided\n## Instructions and signatures for valid completion\n## Background information and eligibility under Wisconsin statutes\n## Guidelines for completing and ordering bracelets","[{\"question\":\"What identifies a patient as DNR in an emergency?\",\"answer\":\"Only the Do Not Resuscitate (DNR) bracelet identifies that the patient is DNR.\"},{\"question\":\"What emergency treatments will personnel provide under this DNR order?\",\"answer\":\"Emergency personnel will provide a clear airway, oxygen, comfort positioning, splinting, bleeding control, pain medication, emotional support, and contact hospice or home health if involved.\"},{\"question\":\"What does the DNR order prohibit in an emergency?\",\"answer\":\"Emergency personnel will not perform chest compressions, insert advanced airways, administer cardiac resuscitation drugs, provide ventilator assistance, or defibrillate.\"}]","Emergency Care - Do Not Resuscitate Order (DNR) - Instructions | PDF",1789845500]