Michigan Do Not Resuscitate Form: Signing, Bracelet, and Revocation

The Michigan Do Not Resuscitate form is available from most hospice providers, and you can also request one from your physician or a hospital.¹ Once completed, it is a medical order telling emergency responders and healthcare providers not to perform CPR if your heart or breathing stops. To be valid, it needs signatures from you (or your authorized representative), your attending physician, and two adult witnesses.²

What the Order Covers

A Michigan DNR answers one question: whether medical personnel should try to restart your heart or breathing. With the order in place, providers will not perform chest compressions, use a defibrillator, insert a breathing tube, or give emergency cardiac drugs during cardiac or respiratory arrest.

Every other kind of treatment continues. You still receive pain medication, IV fluids, oxygen, antibiotics, and anything else aimed at keeping you comfortable or managing your conditions. The order takes effect only at the moment of arrest.

One boundary matters here. Michigan’s Do-Not-Resuscitate Procedure Act governs situations outside a hospital. Inside a hospital, your physician places a DNR directly in your chart through the facility’s own procedures. The state form is what you need at home, in a nursing facility, or anywhere hospital staff are not immediately present.

Who Can Sign

Michigan law identifies several people who may sign a DNR:²

You, if you are at least 18 and of sound mind.
Your patient advocate, if you designated one under Michigan’s Estates and Protected Individuals Code with authority over medical decisions.
A court-appointed guardian, under MCL 333.1053a, if the guardianship order grants authority over medical decisions. A DNR signed by a guardian is valid for one year and must be reaffirmed to stay in effect.
A parent, on behalf of a minor child, under MCL 333.1053b.

If you are physically unable to sign, another person can sign in your presence and at your direction, so long as you are there and clearly giving the instruction.² The physician and witness requirements are the same either way.

Completing the Form

Where to Get It

The official form comes from most hospice providers in Michigan.¹ Your primary care physician, a hospital discharge team, or the social work department at most medical centers can also supply one. There is no fee.

What You Fill In

The form asks for your full legal name, date of birth, and address. Those fields identify you to emergency responders who may see the form with no other knowledge of your medical history.

The Required Signatures

Three groups of signatures make the form valid:²

You, your patient advocate, or someone signing at your direction in your presence.
Your attending physician. The physician’s signature turns the document into a binding medical order.
Two witnesses, both at least 18. At least one of them cannot be your spouse, parent, child, grandchild, sibling, or expected heir.

Each witness must believe you appear to be of sound mind and free from pressure, fraud, or manipulation at the time of signing.² Every name should be printed or typed beneath the corresponding signature. Finding two eligible witnesses on short notice is a common snag, so coordinate with your physician’s office in advance. Staff members can often serve as witnesses during your appointment.

The DNR Identification Bracelet

Michigan law also authorizes a DNR identification bracelet or necklace as a portable way to communicate your wishes. The bracelet must be imprinted with the words “DO-NOT-RESUSCITATE ORDER” along with your name, address, and your physician’s name and phone number.

The bracelet does what paper cannot. Paramedics arriving at a cardiac arrest may not know to look in the kitchen or beside your bed. And if you collapse in public, the form at home is out of reach. A bracelet is the one signal that travels with you. Ask your physician or hospice provider about how to order one.

Making Sure the Order Is Followed

A valid DNR does nothing if no one can find it. Keep the original in a visible spot. Many people tape it to the front of the refrigerator or the inside of the front door, the first places paramedics tend to check.

Give copies to everyone involved in your care: your primary physician, specialists, hospice team, and the administration at any assisted living or nursing facility. Ask each provider to add the DNR to your medical record.

Talk to your family. A relative who does not know about the order, or who disagrees with it, can create confusion during a crisis. Be direct about what you want and why. Agreement is not the point. Knowledge is.

Revoking the Order

You can cancel your DNR at any time while you have the mental capacity to make that decision. No paperwork is required. Telling your physician or another healthcare provider that you want to revoke the order is enough. Destroying every copy adds certainty, since a paramedic who finds an old form on your refrigerator will not know it has been canceled.

If a patient advocate signed on your behalf, that advocate can also revoke it. The same applies to a court-appointed guardian.

After revoking, notify everyone who has a copy: physicians, hospice team, family, and any care facilities. If you wear a DNR identification bracelet, remove it. An active bracelet on your wrist will carry more weight with arriving paramedics than a verbal revocation relayed by a family member.

When MI-POST Might Be a Better Fit

A standard DNR answers only the CPR question. Michigan also offers a broader form called MI-POST (Michigan Physician Orders for Scope of Treatment) that covers more decisions. MI-POST is a one-page, two-sided medical order addressing CPR, critical care interventions, and other treatments you do or do not want during a medical crisis.³

MI-POST is designed for people with serious advanced illness or frailty. It is signed by you (or your representative) and a physician, nurse practitioner, or physician assistant, and it guides care only when you cannot communicate your preferences directly.³

If your only goal is to decline CPR, the standard DNR is enough. If your wishes are more specific, say, comfort-focused care but no ventilator, or some interventions but not others, MI-POST gives your care team clearer guidance. Your physician can help you decide, and nothing prevents you from completing both.

Medicare Coverage for the Conversation

If you are enrolled in Medicare Part B, the consultation with your physician to discuss and complete a DNR or other advance directive is a covered service.⁴

When the conversation happens on the same day as your annual Medicare Wellness Visit and with the same provider, Medicare waives both the Part B deductible and coinsurance, so you pay nothing out of pocket.⁴ If the discussion happens on a separate day, standard Part B cost-sharing applies. Scheduling the planning conversation to coincide with your wellness visit is the simplest way to avoid a bill.

There is no limit on how many of these covered conversations you can have, though your provider needs to document a change in your health status or wishes each time they bill for a follow-up session.⁴

1
State of Michigan. Michigan’s Do-Not-Resuscitate Procedure Act
2
Michigan Legislature. Michigan Code 333.1053 – Execution of Do-Not-Resuscitate Order
3
State of Michigan. MI-POST
4
Centers for Medicare & Medicaid Services. Billing and Coding: Advance Care Planning