A Do Not Resuscitate order does not need to be notarized in California. The state’s standalone prehospital DNR form becomes legally effective with just two signatures: the patient’s (or an authorized decision-maker’s) and the patient’s physician’s. No notary, no witnesses, no court filing. Notarization only enters the picture when DNR instructions are folded into an Advance Health Care Directive, and even then it is one of two acceptable options.
What a California Prehospital DNR Actually Requires
The prehospital DNR form was developed jointly by the California Emergency Medical Services Authority and the California Medical Association. It has no notarization requirement. To be valid, the form needs the patient’s signature (or the signature of someone who holds a power of attorney for health care on the patient’s behalf) and the physician’s signature confirming informed consent.1California Emergency Medical Services Authority. DNR and POLST Forms
People often expect something more formal because other end-of-life documents involve notarization. The confusion usually traces back to mixing up a standalone DNR with an Advance Health Care Directive. Those are two different documents governed by two different rules.
One scope point worth stating plainly: a DNR covers cardiopulmonary resuscitation and nothing else. It does not address pain medication, IV fluids, or nutrition.2MedlinePlus. Do-Not-Resuscitate Order If you want to direct care across a wider range of interventions, you need a POLST form or an Advance Health Care Directive, not a DNR.
When Notarization Does Come Up: Advance Health Care Directives
An Advance Health Care Directive is the broader document. It lets you appoint a healthcare agent, record treatment preferences, and include DNR instructions in one place. Under California Probate Code Section 4701, an AHCD must either be signed by two qualified witnesses or acknowledged before a notary public.3California Legislative Information. California Code PROB 4701 – Advance Health Care Directive Form Notarization is an alternative to witnessing, not an added step on top of it.
If you go the witness route, California law under Probate Code Section 4674 disqualifies several categories of people from serving:4California Legislative Information. California Code PROB 4674 – Witness Restrictions
- Your healthcare provider or anyone employed by your healthcare provider.
- The operator or any employee of a community care facility or residential care facility for the elderly where you live.
- The person you are naming as your healthcare agent.
On top of those restrictions, at least one of the two witnesses (not both) must not be related to you by blood, marriage, or adoption and must not stand to inherit from your estate.4California Legislative Information. California Code PROB 4674 – Witness Restrictions If you live in a skilled nursing facility, one witness must be a patient advocate or ombudsman designated by the State Department of Aging.
Given those rules, notarization is often simpler than lining up two qualified witnesses. A California notary can charge up to $15 per signature acknowledgment, so the cost is modest.
How to Create a Valid DNR in California
The official prehospital DNR form must be in writing and signed by both the patient and the patient’s physician. If the patient cannot make or communicate healthcare decisions, someone with legal authority to decide, such as the holder of a durable power of attorney for health care, may sign in the patient’s place.1California Emergency Medical Services Authority. DNR and POLST Forms The physician’s signature confirms that the patient or decision-maker gave informed consent to forgo resuscitation.
You can purchase the official form from the California Medical Association’s publications office at 1-800-882-1262 or through their online store.5California Medical Association. Do Not Resuscitate (DNR) Form (English) Your physician’s office or a hospital may also have copies on hand.
If your physician has a moral objection to signing a DNR, professional ethics standards generally require them to inform you of all relevant treatment options and refer you to another physician who will honor your wishes. A physician who declines to sign cannot leave you without options.
Making Sure the DNR Is Honored in an Emergency
A signed DNR sitting in a drawer at home will not help if paramedics cannot find it. EMS personnel responding to a cardiac arrest have seconds to decide whether to start CPR. If they cannot locate a valid DNR form or a DNR medallion, they will resuscitate. A family member’s word is not enough.1California Emergency Medical Services Authority. DNR and POLST Forms
California recognizes three instruments for communicating a DNR to prehospital EMS personnel:6Emergency Medical Services Authority. EMS Personnel Guidelines Limiting Pre-Hospital Care
- The official prehospital DNR form, kept somewhere visible such as a refrigerator or bedside table.
- A POLST (Physician Orders for Life-Sustaining Treatment) form, which covers resuscitation along with other treatment preferences.
- An EMSA-approved DNR medallion worn by the patient as a bracelet or necklace. For patients outside a medical facility, this is often the most reliable form of identification because EMS can see it immediately without hunting for paperwork.
Local EMS agencies may accept other documents as well, such as a physician’s order in a patient’s chart containing the words “Do Not Resuscitate” with the patient’s name, date, and physician signature.6Emergency Medical Services Authority. EMS Personnel Guidelines Limiting Pre-Hospital Care A durable power of attorney for health care or a living will is much harder for paramedics to interpret in the field, so EMS will usually default to resuscitation if there is any doubt.1California Emergency Medical Services Authority. DNR and POLST Forms
A POLST also does not require notarization or witnesses. It needs the patient’s signature (or that of their legally recognized decision-maker) and a signature from a physician, nurse practitioner, or physician assistant.7California Department of Public Health. About Physician Orders for Life-Sustaining Treatment POLST forms are typically printed on bright pink paper so medical staff can spot them quickly, but a POLST on any color paper is legally valid.
Changing or Revoking a DNR
A DNR can be revoked at any time. The simplest way is to destroy the form and remove any DNR medallions; the prehospital DNR form itself confirms that destroying the document revokes it.8California Emergency Medical Services Authority. Prehospital Do Not Resuscitate Form California regulations for residential care settings also recognize verbal revocation, so a patient can tell their care team to cancel the DNR.9Legal Information Institute. California Code of Regulations Title 22 Section 87924 – Do Not Resuscitate Order
After revoking, notify your physician, destroy all copies of the form (including any filed with the MedAlert Foundation or other approved supplier), and destroy or return any medallions and wallet cards.8California Emergency Medical Services Authority. Prehospital Do Not Resuscitate Form A stray copy left behind in a hospital or care facility could lead to confusion during an emergency. A POLST can likewise be modified or revoked at any time, verbally or in writing, by the patient, by a physician acting on new medical information, or by a decision-maker if the patient has lost capacity. When preferences change, a new POLST should be completed and signed to reflect them.