Under New York DNR law, a Do Not Resuscitate order is a signed medical directive telling healthcare providers and emergency responders to withhold cardiopulmonary resuscitation if your heart or breathing stops. Outside of hospitals, these orders are governed by Public Health Law Article 29-CCC, and when a patient cannot decide for themselves, the Family Health Care Decisions Act (Article 29-CC) controls who can consent on their behalf. A valid order requires the right form, the right signatures, and — just as important — a place where paramedics can actually find it.
Who Can Consent to a DNR
New York starts from a presumption that every adult has capacity to decide whether they want CPR. That presumption holds unless a physician formally determines otherwise, and a prior court appointment of a guardian over your property or finances does not, by itself, take the decision away from you. Capacity for DNR purposes is evaluated on its own terms.
To consent for yourself, you must understand what CPR involves, the consequences of forgoing it, and the risks and benefits of your choice. A physician evaluates that understanding. If a physician concludes you lack capacity, the determination has to be documented in writing with the cause and probable duration of the incapacity, and confirmed by a concurring second physician. When the incapacity stems from mental illness, the concurring physician must be board-certified or board-eligible in psychiatry and neurology.
Surrogates When You Cannot Decide
If you lack capacity, the Family Health Care Decisions Act sets a ranked list of who can consent for you. The highest-ranked person who is available and willing acts as the surrogate:
- A guardian authorized to make health care decisions under Article 81 of the Mental Hygiene Law
- A health care agent named in your health care proxy
- A spouse or domestic partner, unless legally separated
- An adult child, age 18 or older
- A parent
- An adult sibling, age 18 or older
- A close friend
The surrogate must decide based on what you would have wanted, drawing on your known wishes, religious beliefs, and moral values. If your wishes are unknown, the decision falls to your best interests.
Consenting for a Minor
A parent or legal guardian can consent to a DNR for a child under 18, with additional safeguards. The attending physician must first determine, with written agreement from a second physician, that the minor has a qualifying medical condition. If the minor has capacity to participate, their consent is also required. The attending physician must make reasonable efforts to notify any non-custodial parent who has maintained regular contact with the child before the order takes effect.
The Two Forms: DOH-3474 and MOLST
A valid nonhospital DNR in New York uses one of two official forms: the Department of Health Form DOH-3474 or the MOLST form (DOH-5003). The DOH-3474 is the traditional standalone nonhospital DNR. It records your full legal name and date of birth and carries a single directive: do not resuscitate. You can get it from the New York State Department of Health website or your doctor’s office, and hospitals and long-term care facilities typically keep copies on hand during discharge planning. Use the current version and keep the original somewhere it can be found quickly.
MOLST — Medical Orders for Life-Sustaining Treatment — is the broader document. Under state law it is actually the only authorized form in New York for documenting both a nonhospital DNR and a nonhospital Do Not Intubate order on a single page. It is designed for people with serious health conditions, particularly those in long-term care, requiring ongoing medical services, or who might die within the next year. Beyond CPR, MOLST can include orders about intubation and mechanical ventilation, feeding tubes, antibiotics, and whether to attempt hospital transfer during an emergency. A dedicated section allows added instructions, such as decisions about implantable defibrillators.
If your only concern is CPR, the DOH-3474 works fine. If you want a single portable document that covers a range of end-of-life decisions, MOLST is the better tool. EMS providers recognize both.
Signatures and Witnesses
The form must be signed by a licensed physician, nurse practitioner, or physician assistant who has evaluated you. The signing clinician provides their printed name, license number, and the date. That signature is what converts your preference into a binding medical order. One exception applies for individuals with intellectual or developmental disabilities: in that context, only a physician may sign.
The number of witnesses depends on who is consenting. If you have capacity and are signing for yourself, your written consent must be dated and signed in the presence of at least two adult witnesses. If a surrogate consents on behalf of someone who lacks capacity, one adult witness is required. The same single-witness rule applies when a parent or guardian consents for a minor. Each witness signs the document.
Making the Order Findable in an Emergency
A signed form that nobody can find is the same as no form at all. EMS personnel who arrive at a home and do not see a valid DOH-3474 or MOLST, or a state-approved DNR bracelet, are legally required to begin resuscitation. This is where families get caught out: the form exists, but it sits in a filing cabinet while paramedics are working. Keep the form in an immediately visible spot such as the refrigerator or near the front door. Completing multiple copies lets you keep one displayed at home and give others to your health care agent and primary care provider.
The DNR Bracelet
New York authorizes a standard metal bracelet as a secondary identifier. It must display a caduceus symbol and the words “DO NOT Resuscitate.” When EMS providers see a qualifying bracelet, they should assume a valid DNR order exists. The bracelet is especially useful if someone is found away from home or during transport, and it works alongside the written form rather than replacing it.
Inside Hospitals and Nursing Homes
Once you are admitted to a facility, the DNR becomes part of your medical record. Staff use color-coded wristbands or signs near the bed so every member of the care team knows. The facility verifies the document at intake so the order carries through the stay without gaps.
Revoking a DNR
You can revoke a DNR at any time, and the standard is deliberately broad: any act showing a specific intent to revoke counts. Telling a physician, nurse, or paramedic that you no longer want the order works. So does destroying the form. A surrogate who originally consented can revoke on the same terms.
Once a healthcare professional learns of the revocation, they must notify the attending physician, who cancels the order in the medical record and makes a genuine effort to retrieve the physical form and any bracelet. That retrieval step matters. A revoked order still sitting on the refrigerator can lead responders to honor an order that no longer reflects your wishes. If you revoke, remove every copy yourself, take off the bracelet, and confirm that your health care agent and family know the order is no longer active.
How a Health Care Proxy Fits In
A health care proxy and a DNR do different jobs. A proxy, authorized by Article 29-C of the Public Health Law, is the document in which you appoint a health care agent to make medical decisions if you lose capacity. It does not contain specific medical orders. A DNR is a specific medical order telling providers to withhold CPR now.
The two connect when capacity changes. If you signed a proxy while competent and later lose capacity, your agent can direct a physician to issue a DNR on your behalf, deciding as you would have based on your known wishes or best interests. Without a proxy, the surrogate hierarchy under the Family Health Care Decisions Act picks the decider by default, and that ranking may not match the person you would actually trust. Naming an agent puts that choice in your hands while you still have it.
Extra Safeguards for Individuals With Developmental Disabilities
New York imposes additional protections when a person with an intellectual or developmental disability lacks capacity and has no health care proxy. Before a MOLST can be signed, the facility must complete the MOLST Legal Requirements Checklist for Individuals with I/DD. The checklist requires the attending physician’s determination of incapacity, a concurring opinion from a second physician or a licensed psychologist with relevant experience, a medical determination that the individual meets specific clinical criteria, and notice to designated parties before the order takes effect. Only a physician may sign the order in this context; nurse practitioners and physician assistants cannot.