Michigan Do Not Resuscitate Order Template
This Do Not Resuscitate (DNR) Order is created in accordance with Michigan state laws regarding the end-of-life care. It is designed to communicate a person's wishes regarding resuscitation in case of cardiac or respiratory arrest.
Please fill out the following information accurately:
- Patient's Full Name: __________________________
- Date of Birth: __________________________
- Address: ________________________________
- City, State, Zip Code: ________________________________
- Name of Physician: __________________________
- Physician's Contact Number: __________________________
- Date of DNR Order Completion: __________________________
By signing below, I, the undersigned, express my wish that resuscitation measures not be initiated on my behalf:
Signature of Patient or Legal Guardian: __________________________
Relationship to Patient: __________________________
Date: __________________________
This document should be kept in an accessible location and shared with all relevant healthcare providers to ensure that your wishes are honored. Consider discussing these wishes with family members and caregivers for clarity and support.
For more detailed information or assistance, consult a healthcare provider or legal professional familiar with end-of-life care in Michigan.