Understanding the wisconsin do not resuscitate form, and wi do not resuscitate form, can be a relief for patients and families planning ahead. In this guide, I share how to use a free downloadable template to clearly express CPR wishes, who can authorize it, and how to keep it up to date. From my experience drafting templates for healthcare clients, a well-structured DNR document helps reduce confusion in emergencies and ensures family values are reflected in medical care. This article blends practical drafting tips with a step-by-step approach you can adapt for Wisconsin settings.
Disclaimer: Not legal advice; consult pro.
What is a Do Not Resuscitate (DNR) Order and Why It Matters in Wisconsin
A Do Not Resuscitate (DNR) order is a medical directive that communicates a patient’s wish not to receive cardiopulmonary resuscitation (CPR) if their heart stops beating or breathing ceases. In Wisconsin, as in many states, a DNR is a medical order, not a general preference or a living will alone. Medical professionals, institutions, and EMS personnel look for a valid DNR order to guide care during emergencies or acute events. The Wisconsin system also includes related forms and orders—such as standing orders or scope-of-treatment documents—that help specify the level of intervention a patient wants in different care settings, from hospitals to home care.
In practice, a Wisconsin DNR order requires a physician’s signature to be valid as a standing medical order. The patient or their legally authorized representative (such as a health care surrogate) typically participates in decisions about resuscitation, but the physician must translate those decisions into an officially recognized order. This process helps ensure that a patient’s preferences are respected across care settings and reduces the likelihood that unwanted resuscitation attempts occur in the heat of an emergency.
Key differences between WI DNR and related Wisconsin orders
- DNR vs. POST: A DNR order explicitly instructs medical teams not to perform CPR, while a POST (Physician’s Order for Scope of Treatment) clarifies a broader range of interventions, goals of care, and the overall treatment plan.
- Documentation flow: A DNR is a focused order about resuscitation, often carried with the patient’s chart; a POST or similar form covers values-based treatment decisions across a spectrum of life-sustaining interventions.
- Setting: DNR orders are used in hospitals, clinics, emergency services, and home care if recognized; POST-type orders aim to align care across multiple settings for a patient’s plan.
How the Wisconsin DNR Form is Used
The Wisconsin approach emphasizes that a DNR is a medical order that healthcare professionals must honor, provided the order is valid, current, and applicable to the patient in the present setting. A DNR may be carried in a patient’s medical record, on a portable wallet card, or embedded within electronic health records (EHRs) when the facility has the capability. The practical effect is straightforward: if CPR is attempted, it should not be initiated or continued in accordance with the documented wishes, absent a revocation or a later change in direction by the patient or their authorized representative and physician.
People often interact with a DNR in three contexts: in a hospital admission, during home or community-based care, and when transporting between care environments (for example, from home to hospital). Wisconsin’s systems strive to preserve the patient’s preferences consistently across these contexts, but it’s important to review the status whenever care plans change, such as after a new diagnosis, a shift in prognosis, or changes in treatment goals.
Elements of a Free WI DNR Template
A well-crafted template helps ensure that all essential elements are captured, reduces ambiguity, and can be quickly understood by clinicians in an emergency. The free downloadable WI DNR template described here covers core components commonly requested by clinicians, families, and care teams. You can customize the fields to match your situation while maintaining a clear, compliant structure.
| Field | Guidance | Required? |
|---|---|---|
| Patient Information | Full legal name, date of birth, current address, and contact information. If the patient uses a preferred name or nickname, include it for clarity. | Yes |
| Medical Provider Details | Name of physician or advanced practice clinician, practice or hospital, contact information, and (if available) license number. | Yes |
| CPR Instructions | Explicit statement about CPR: perform CPR or do not perform CPR, including any exceptions (e.g., for ongoing life-support devices only). | Yes |
| Treatment Scope (if POST is used) | Broader decisions about the level of intervention, such as intubation, mechanical ventilation, and admission decisions. | Optional (depends on form type) |
| Effective Date and Time | When the order becomes effective and for how long it remains in effect. Note any expiration or revocation process. | Yes |
| Signatures | Patient or legally authorized representative, witness(es) as required by Wisconsin guidelines, and the physician’s signature. Some forms require a nurse or other clinician as a witness. | Yes |
| Revocation Clause | Instructions on how the order may be revoked or updated, and by whom. | Yes |
| Location of Copies | Where the original medical record will hold the DNR order, plus copies stored in accessible places (e.g., wallet card for the patient, copies to family, and EMS services if possible). | Yes |
| Notes or Special Considerations | Any patient-specific preferences, religious or cultural considerations, or guidance about comfort measures and palliative care. | Optional |
Step-by-Step: Completing Your wi do not resuscitate form
- Initiate a conversation with a clinician: Begin with an open dialogue with the patient’s physician or primary clinician to understand how DNR decisions align with medical realities and prognosis. This conversation also helps ensure the form is medically appropriate and that what you record reflects current wishes.
- Clarify goals of care: Discuss comfort-focused measures, quality of life, and the patient’s values. If applicable, consider how the DNR fits within a broader plan such as a POST or goals-of-care discussion.
- Choose the correct form type: Confirm whether a standalone DNR form or a broader POST form best reflects the patient’s desires. Wisconsin uses variations that may have different fields and signatures.
- Fill out the template with accuracy: Provide the patient’s legal name, date of birth, and contact information; insert the physician’s details; specify CPR instructions clearly; add dates, times, and revocation options; and ensure signatures and witnesses are in place.
- Review for accuracy and clarity: Read through the document to confirm that the instructions are unambiguous and that there are no contradictory statements. If you’re unsure, request a clinician’s review before signing.
- Sign and witness as required: Complete the signature lines with patient or legally authorized representative, physician, and required witnesses. Some Wisconsin forms require specific witness arrangements; follow local guidance to ensure validity.
- Distribute and store copies: Provide copies to the patient, surrogate, primary care provider, and EMS or hospitals as appropriate. Keep the original in the patient’s medical record and, if possible, carry a wallet-sized card that indicates the DNR status.
- Review periodically and update: Revisit the DNR status when the patient’s health changes, after hospital admissions, or during significant shifts in care goals. Updates should be re-signed by the physician and witnesses to remain valid.
Legal Considerations and Practical Tips
While this guide and the template can be very helpful, they are not a substitute for professional legal advice. Wisconsin’s requirements for DNR documentation can vary by setting, and changes to the patient’s health or preferences may necessitate updates to the form. Some key practical considerations include ensuring that the form is current, that it is readily accessible to all care providers, and that family members understand the patient’s wishes to minimize confusion if the patient cannot communicate during a medical emergency.
If you’re working with a health care proxy or surrogate, make sure the surrogate clearly understands the patient’s preferences and the circumstances under which resuscitation would be pursued or withheld. When possible, document conversations and decisions in the form itself or in a companion advance care plan, so medical teams have context about the patient’s values.
Downloadable Template: How to Use and Customize
This article provides a free downloadable WI DNR template designed to be practical for patients, families, and clinicians. The template is available in commonly used formats (PDF and Word) to support easy signing and sharing. You can customize the form to reflect your unique medical situation, language preferences, and care goals, while keeping the document aligned with Wisconsin practice standards.
To access the free template, click the link below. It’s crafted with forms that closely mirror typical Wisconsin DNR and POST documents, and it includes guidance notes to help you fill in each field correctly. As with any legal or medical document, review the final version with a clinician to confirm its validity within your care setting.
Download the free WI DNR template: Download free Wisconsin DNR template (wi do not resuscitate form).
Template preview: key fields and example language
- Patient name and identifying information: “John A. Doe, date of birth 01/01/1950, residing at 123 Main Street, Anytown, WI.”
- Physician information: “Dr. Jane Smith, MD, Anytown Medical Group, License #12345.”
- CPR decision: “Do not perform CPR if the patient’s heart stops or if breathing stops.”
- Effective date/time: “Effective 2025-11-01 at 08:00.”
- Signatures and witnesses: “Patient or surrogate signature, physician signature, witness initials.”
- Revocation and updates: “Any revocation must be in writing and signed by the patient or surrogate and physician; updated orders supersede prior versions.”
- Copy distribution: “Original placed in medical record; copies to emergency contact, primary care, EMS; wallet card provided.”
Addressing Common Questions About Wisconsin DNR Forms
Who can sign a Wisconsin DNR form?
In Wisconsin, the patient or a legally authorized representative (such as a health care surrogate) may participate in consenting to a DNR order, but a physician or qualified clinician must translate that decision into a formal medical order. In practice, the exact requirements for signatures and witnesses may vary by facility and form type, so it’s prudent to confirm with the treating clinician or the healthcare institution.
Can a DNR be changed or revoked?
Yes. A DNR order can be changed or revoked at any time by the patient (if capable) or by a legally authorized representative with the physician’s involvement. If the patient’s condition changes, it’s important to revisit the conversation with the care team to decide whether the DNR status remains aligned with goals of care.
Is a DNR valid across all care settings in Wisconsin?
Wisconsin aims to recognize DNR orders across hospital, clinic, and home care settings, but the form’s validity may depend on the setting and whether the order is integrated into the patient’s electronic medical record or carried on a portable document (wallet card). Always verify that EMS and out-of-hospital providers have access to the most recent order.
IRS Considerations and Tax Implications Related to Medical Planning
Tax planning can intersect with medical decision-making in several ways. For families managing medical costs and long-term care, certain unreimbursed medical expenses may be deductible if they exceed the IRS threshold for itemized deductions. The IRS outlines the limits and definitions for medical and dental expenses, including which costs qualify for deduction. While a DNR form itself is not a tax document, the associated medical planning may involve expenses that are potentially deductible under current rules.
For a detailed explanation of what counts as deductible medical expenses, you can consult IRS guidance such as IRS Topic 502, Medical and Dental Expenses. This resource explains what expenses qualify, how to calculate the deduction, and where to report it on your tax return. Note that tax laws change, and individual circumstances vary, so consulting a tax professional is advisable for tailored guidance.
IRS sources: - IRS Topic 502: Medical and Dental Expenses — irs.gov/taxtopics/tc502 - Publication 502 (Medical and Dental Expenses) — irs.gov/pub/irs-pdf/p502.pdf
Practical Considerations for Caregivers and Families
Implementing a Wisconsin DNR form is a collaborative process. For families, the goal is to ensure that the patient’s values and preferences are documented clearly and accessible to care teams. From a practical standpoint, here are strategies that can help:
- Start early: Begin conversations before a health crisis occurs, ideally when the patient is alert and able to participate.
- Involve a trusted clinician: A physician or palliative care professional can help translate preferences into appropriate medical orders.
- Keep documents accessible: Store the original form in the medical record and provide copies to the surrogate, family members, and EMS if possible.
- Revisit periodically: Review the document during major health changes, hospital admissions, or shifts in goals of care.
- Document preferences for comfort care: Include notes about pain control, comfort measures, and any spiritual or cultural considerations that matter to the patient.
In my practice, I emphasize that a well-drafted WI DNR template is not just about withholding intervention; it is about shaping a care plan that respects dignity, reduces unnecessary restraint of care, and aligns with what matters most to the patient and their family. Clear language, consistent terminology, and timely updates make a meaningful difference when a patient faces an acute event.
Frequently Asked Questions (FAQ)
Is a WI DNR form the same as a living will?
A living will typically documents preferences for future medical care when a person cannot speak for themselves, whereas a DNR is a specific medical order directing responders not to perform CPR. In Wisconsin, you may have both in your overall advance care plan, but they serve different purposes and are processed through different channels.
What should I do if the patient moves to another state?
DNR recognition across state lines can vary. If a patient relocates, it’s important to review and, if needed, re-execute a DNR or POST form under the new state’s rules, and to ensure that medical providers in the new location have access to the most current orders. Always carry documentation that clearly states the patient’s wishes and the responsible physician’s contact information.
How can I ensure my template remains compliant with Wisconsin requirements?
Regular consultations with a clinician or attorney who specializes in elder care or medical law can help ensure the template aligns with current Wisconsin requirements and practice standards. As guidelines evolve, updating the form and obtaining re-signatures when needed helps maintain its validity.
Conclusion: A Practical Path to Respecting Patient Wishes
A free downloadable WI DNR template can be a practical and empowering tool for patients, families, and clinicians. By clearly documenting CPR preferences and related care decisions, you reduce ambiguity, support patient autonomy, and help care teams deliver care that aligns with the person’s values. The process—rooted in conversation, physician involvement, and careful documentation—builds a foundation of trust that benefits everyone during stressful times.
If you’d like to start now, use the free template linked earlier to begin outlining the Wisconsin DNR details that reflect your wishes and circumstances. Remember to review the document with your physician and consider including related advance care planning materials to accompany the DNR, such as goals-of-care discussions or a POST form if applicable.
Key takeaways
- In Wisconsin, a DNR order is a medical directive that must be properly documented and signed by the appropriate clinician and the patient or surrogate.
- A free downloadable template can help standardize the information, but it should be reviewed by a clinician to ensure accuracy and compliance with Wisconsin requirements.
- Keep copies accessible to care teams, family members, and EMS, and plan periodic reviews to reflect changes in health status or patient preferences.
- Tax considerations related to medical planning can involve deductible medical expenses; consult IRS Topic 502 for guidance and talk to a tax professional for personalized advice.
For ongoing support, consider connecting with patient advocacy resources, hospice and palliative care programs, and local Wisconsin health systems that can provide guidance on DNR forms and related advance care planning tools. If you’re drafting this template for the first time, you’re taking a responsible step toward ensuring that medical care aligns with what matters most to you or your loved one.