How to Fill Out the Nebraska Do Not Resuscitate (DNR) Order Form

A Nebraska Do Not Resuscitate (DNR) order form is a short, physician-signed document that tells paramedics and EMTs not to perform CPR if your heart stops or you stop breathing. To put one in place, you get the form from your physician or healthcare facility, complete every field, have you (or your surrogate) and the physician sign it, and then keep the signed order somewhere emergency responders will actually find it.

Which Form You Actually Need

Nebraska uses more than one document in this area, and picking the wrong one is the most common early mistake. A standalone physician’s DNR order is narrow: it covers only CPR, meaning chest compressions, defibrillation, and intubation when cardiac or respiratory arrest occurs. If that is all you want to address, a DNR order is enough.

The Nebraska Emergency Treatment Declaration and Orders (NETO) form is the state’s broader version, functioning like a POLST. It gives you three CPR options: attempt CPR, do not attempt CPR except during a medical procedure you have consented to, or do not attempt CPR at all. It also covers intubation and EMS transport preferences.¹ If you want to limit other emergency interventions in addition to CPR, choose the NETO. If you only want to refuse CPR, the physician’s DNR order is sufficient.

A living will (called a “declaration” under Nebraska law) is a separate document that addresses life-sustaining treatment generally if you develop a terminal condition or enter a persistent vegetative state. It does not replace a DNR order, because EMS personnel at the scene need an immediate medical order, not an advance directive to interpret.

Who Can Sign

Any adult of sound mind can request a DNR order at any time.² You do not need to be terminally ill to execute the form, though your physician will want to discuss your medical situation before signing it.

If you lack the capacity to make medical decisions, someone else can request a DNR on your behalf. A person you previously named through a durable power of attorney for health care has that authority. If no power of attorney exists, Nebraska’s Health Care Surrogacy Act sets a priority order: spouse (unless legally separated or divorce is pending), then adult child, then parent, then adult sibling.³ A person who has shown special care and concern for you and knows your values can also qualify.

Where to Get the Form

The most reliable source is your physician’s office or the healthcare facility where you receive care. The City of Lincoln makes its physician’s DNR order form publicly available through its fire and EMS division.⁴ For the NETO form, materials are available through the Nebraska NETO program.¹ The Nebraska Department of Health and Human Services also provides advance directive information and can point you to the appropriate documents.⁵

There is no fee for the forms themselves. You may incur a small cost if you use a notary public.

Filling Out the Form, Field by Field

The form is short, but incomplete forms can be returned as invalid, so fill in every field before you take it in for signatures.⁴

Start with your full legal name and date of birth. Paramedics use these to confirm they are looking at the right person’s order during a high-stress call, so make sure the name matches your government-issued identification exactly.

Next is the election to withhold resuscitative efforts. On the standard physician’s DNR order, you select the option directing emergency personnel not to perform CPR. On the NETO, you choose among the three CPR options and, if you want, address intubation and EMS transport. Be deliberate about each selection. Ambiguity here defeats the purpose of the document.

The physician section requires the printed name and signature of the medical provider who discussed your condition and prognosis with you. That signature is what turns a personal wish into a binding medical order. On the NETO form, the provider must also include their license number and office phone number.¹

Signatures and Witnesses

A DNR order requires the physician’s signature to be valid. You, or your surrogate, also sign to confirm that you understand what the form means and agree to it. The physician’s signature certifies that they have discussed your medical situation, treatment options, and prognosis, and that the DNR order is medically appropriate.

For the declaration portion of the NETO form, which functions as an advance directive, Nebraska law requires either two adult witnesses or a notary public.² If you use witnesses, no more than one can be an employee or administrator of the healthcare provider currently caring for you, and neither witness can be an employee of your life or health insurance company. Those restrictions do not apply if you use a notary. For a standalone physician’s DNR order, the physician’s signature is the critical requirement.

A copy of the signed DNR order carries the same legal weight as the original.⁴ Make several copies and give them to your physician, any facility where you receive care, your surrogate or power of attorney agent, and close family members.

Where to Keep It So It Works

A signed DNR order that paramedics cannot locate is functionally useless. Without the physical document in hand, EMS personnel will perform full resuscitation. The most common placements for home use are the refrigerator door or the head of the bed, where emergency responders are trained to look.

DNR identification bracelets and necklaces are available commercially and can alert responders to check for your paperwork. The bracelet itself is not legally sufficient for EMS to withhold resuscitation; you still need the signed order accessible at the scene.⁶ If you spend time in multiple locations, keep a copy at each one and carry one when you travel.

The NETO form has no expiration date, but the program recommends reviewing it every two years to confirm your choices still reflect your current health status and wishes.¹ A change in diagnosis or a shift in how you feel about end-of-life care is reason enough to revisit it with your physician.

Changing Your Mind

You can revoke a DNR order at any time, in any manner, regardless of your mental or physical condition.⁷ You can destroy the document, write a new statement revoking it, or simply tell your physician or any healthcare provider verbally. The revocation takes effect the moment it is communicated to your attending physician or another provider, who must then record it in your medical file.

If you distributed copies, tell every holder so they can destroy their copies. A stale DNR circulating after revocation can create dangerous confusion during an emergency. The same revocation rules apply to the NETO form.

If You’re Headed Into Surgery

If you have a DNR order and need surgery, expect your anesthesiologist or surgeon to raise the topic before the procedure. Cardiac and respiratory arrest can occur as a predictable side effect of anesthesia, and resuscitating someone in that context is different from resuscitating someone in end-stage illness. There is no universal protocol requiring automatic suspension of a DNR during surgery, and ethicists generally consider blanket suspension policies inappropriate because they override your autonomy.⁸

The standard approach is a “required reconsideration” conversation before surgery, where you and the surgical team decide which interventions you would accept during and immediately after the procedure. The NETO form anticipates this situation with its middle option: do not attempt CPR except for cardiac arrest occurring during a medical intervention or procedure for which you have given consent. If disagreements come up that you and the surgical team cannot resolve, the hospital’s bioethics committee can help mediate.

1
Nebraska Health Network. Nebraska Emergency Treatment Declaration and Orders
2
Nebraska Legislature. Nebraska Code 20-404 – Declaration Relating to Use of Life-Sustaining Treatment
3
Nebraska Legislature. Nebraska Code 30-604 – Powers, Designation of Surrogate, Priorities
4
City of Lincoln, Nebraska. Physician’s Do Not Resuscitate (DNR) Order
5
Nebraska Department of Health and Human Services. Advance Directives
6
StickyJ Medical ID. Nebraska Do Not Resuscitate DNR Bracelets
7
Nebraska Legislature. Nebraska Code 20-406 – Revocation of Declaration
8
PubMed Central. Do Not Resuscitate, Anesthesia, and Perioperative Care: A Not So Clear Order