How to Get and Complete the Wisconsin Do Not Resuscitate Form (F-44763)

The Wisconsin Do Not Resuscitate form, officially Form F-44763, is completed by your attending health care provider and, once signed, gets you a DNR bracelet that tells paramedics not to perform CPR if your heart stops or you stop breathing. The form itself never reaches emergency crews. Only the bracelet does. You will leave the appointment wearing a free plastic band or carrying an order form to buy a metal one from the state’s approved vendor.¹

Who Can Get a Wisconsin DNR Order

You must be at least 18 years old, and your attending health care provider must determine that you meet one of three medical criteria set by state law:²

You have a terminal condition — an illness or injury that will cause death regardless of treatment.
CPR would not restore your heart or lung function, or you would go into repeated cardiac or pulmonary failure shortly before dying.
The physical pain or damage caused by CPR itself would outweigh any chance of restoring heart or lung function for a meaningful period.

The qualifying condition gets documented in your medical record.³ A provider who knows you are pregnant cannot issue the order.

How the Form Gets Completed

You do not order F-44763 yourself. The attending health care provider initiates it. The Department of Health Services posts the PDF online but does not supply printed copies, so in practice your doctor’s office prints it or has it on hand.⁴

The form collects your full legal name, date of birth, sex, and home address, along with your provider’s printed name, phone number, signature, and the date. You (or your guardian or health care agent, if you lack capacity) sign and date it as well.¹ Make sure your identifying information matches your ID. The form becomes the legal foundation for the bracelet and stays in your medical record.

Signing Rules — No Witnesses Needed

The statute requires only two signatures: yours and the attending provider’s. No witnesses, no notary.⁵ If you have been told you need two witnesses, that requirement comes from Wisconsin’s living will (declaration to physicians), which is a different document.

Before you sign, your provider must give you written information about the resuscitation procedures you are choosing to forgo and how you can revoke the order later. This informed-consent step is a legal prerequisite, and the order is not valid without it.³

If Someone Signs on Your Behalf

If you cannot act for yourself, your legal guardian or the health care agent named in your power of attorney for health care can request the order, receive the required information, consent, and sign for you. That same person can later revoke the order using any of the methods available to you.⁶

Getting the Bracelet

The form itself states that it “cannot be used to communicate your wishes to Responders.” The bracelet is what responders look for.¹ You have two options.

The plastic bracelet is free. Your provider puts it on your wrist during the appointment. Each facility uses its own vendor, so DHS does not supply the bands directly. The insert carries the provider’s signature, printed name, work phone number, and the pre-printed State of Wisconsin logo.⁴

For a sturdier option, your provider gives you an order form for a metal bracelet from StickyJ Medical ID, the state-approved vendor based in Seminole, Florida. You mail the order form in. The vendor sets the price, and DHS does not publish it.¹

Wear your bracelet. If you are found without it, or if it appears to have been tampered with or removed, responders are not required to honor the order and will proceed with resuscitation.³

What EMS Will and Won’t Do

When responders arrive and see a valid DNR bracelet, they will not perform:¹

Chest compressions
Defibrillation
Insertion of advanced airways
Ventilator assistance
Cardiac resuscitation drugs

They will still provide comfort measures. Oxygen, pain relief, suctioning, repositioning, and emotional support for you and your family are all on the table. They will also treat conditions unrelated to resuscitation. A broken bone, a wound, or any other problem that does not involve cardiac or respiratory arrest still gets care.⁴

The order addresses one scenario only: your heart stops or you cannot breathe. It does not block any other medical care, and it does not govern treatment decisions made inside a hospital by your physician.

How to Cancel It

You can revoke a DNR order at any time, and the revocation takes effect the moment you act. Any of these works:⁷

Tell any EMS practitioner, emergency responder, or emergency facility staff member that you want to be resuscitated. They will remove the bracelet immediately.
Destroy the bracelet by cutting, burning, defacing, or otherwise damaging it.
Remove the bracelet, or ask someone else to remove it.

You do not have to reach your provider first. Your provider should be notified when practical so the revocation can be documented, but any delay does not affect the validity of your decision. A guardian or health care agent can revoke the order the same way.⁷

Penalties for Interfering With Someone Else’s Order

Concealing, defacing, or damaging another person’s DNR bracelet without their consent is punishable by a fine of up to $500, up to 30 days in jail, or both. The same penalty applies to threatening or intimidating someone into signing or issuing a DNR order. Forging or transferring a bracelet with the intent to withhold resuscitation against the person’s wishes, or concealing a revocation, is a Class F felony.⁸

How a DNR Order Differs From Other Advance Directives

A Wisconsin EMS DNR order is narrower than many people assume. It covers cardiac or respiratory arrest, and it applies to emergency response outside a hospital. Related documents do different work.

A living will, called a declaration to physicians in Wisconsin, covers decisions about life-sustaining treatment when you have a terminal condition or are in a persistent vegetative state, and it applies to decisions your physician makes in a medical facility. It requires witnesses. A power of attorney for health care appoints an agent to make medical decisions when you cannot; the agent can request or revoke a DNR order, but the power of attorney by itself does not instruct responders to withhold CPR.

Some states use a POLST form that covers a broader range of treatments, including mechanical ventilation and feeding tubes. Wisconsin’s EMS DNR order addresses resuscitation only. For other interventions, use a living will or discuss a separate set of physician orders with your provider.

EMS personnel in Wisconsin cannot honor a living will or power of attorney during a call. If that is all you have and you are not wearing a DNR bracelet, responders will perform CPR and transport you to a hospital, where your physician can then review your advance directives.⁴

1
Wisconsin Department of Health Services. Wisconsin F-44763 – Emergency Care Do Not Resuscitate Order
2
Wisconsin State Legislature. Wisconsin Code 154.17 – Definitions
3
Wisconsin State Legislature. Wisconsin Statutes 154.19 – Do-Not-Resuscitate Order
4
Wisconsin Department of Health Services. EMS – Do Not Resuscitate Information
5
Wisconsin State Legislature. Wisconsin Code 154.19 – Do-Not-Resuscitate Order
6
Wisconsin State Legislature. Wisconsin Statutes 154.19 – Do-Not-Resuscitate Order, Section 154.225
7
Wisconsin State Legislature. Wisconsin Statutes 154.19 – Do-Not-Resuscitate Order, Section 154.21
8
Wisconsin State Legislature. Wisconsin Statutes 154.19 – Do-Not-Resuscitate Order, Section 154.29