Do-Not-Resuscitate (DNR) Information
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Under Subchapter III of Wis. Stat.
154 (exit DHS), an attending physician may issue a do-not-resuscitate order for
a "qualified patient," as defined in Wis. Stat. s.
(4) (exit DHS).
A "qualified patient" means a person who
is at least 18 years old and who either has a terminal condition or
has a medical condition such that, were the person to suffer cardiac or
pulmonary failure, resuscitation would be unsuccessful in restoring
cardiac or respiratory function, the person would experience repeated
cardiac or pulmonary failure within a short period before death occurs,
or resuscitation would cause significant physical pain or harm that
would outweigh the possibility the resuscitation would successfully
restore cardiac or respiratory function for an indefinite period of
means cardiopulmonary resuscitation or any component of cardiopulmonary
resuscitation, including cardiac compression, endotracheal intubation
and other advanced airway management, artificial ventilation,
defibrillation, administration of cardiac resuscitation medications and
related procedures. “Resuscitation” does not include the Heimlich
maneuver or similar procedure used to expel an obstruction from the throat.
As defined in
Wis. Stat. s.
a do-not-resuscitate order directs emergency medical technicians, first
responders and emergency health care facilities personnel not to attempt
cardiopulmonary resuscitation on the person for whom the order is issued
if that person suffers cardiac or respiratory arrest. The purpose
of a do-not-resuscitate order is to ensure that medical care provided in
the emergency department and out-of-hospital settings is
consistent with the patient's desire and the attending physician's
are two types of Do Not Resuscitate (DNR) bracelets available to
identify a person with a valid DNR order. One is a plastic ID bracelet
which looks like a hospital identification band and is free. The other
is a metal bracelet which is available from MedicAlert© for a fee. Both
have been used in Wisconsin since 1995 and require a completed
Resuscitate form DPH
F-44763 (PDF, 154 KB) to be completed by
plastic Do Not Resuscitate Bracelet is free of charge and should be
obtained directly from the
physician. With the hospital type bracelet the physician signs an
official insert containing the preprinted logo of the State of
Wisconsin. The insert must include the physician’s name, business
telephone number and signature. Please note that the Department of
Health Services does not supply the plastic bracelets, and there is no
selected vendor. Each facility can use any vendor the facility chooses.
154 (exit DHS), Medic Alert® is the only State of Wisconsin authorized vendor for a permanent type metal bracelet. The metal
bracelet (from MedicAlert®) displays the internationally recognized
Staff of Aesculapius on the front and the words
“Wisconsin-Do-Not-Resuscitate-EMS” and the qualified patient’s
first and last names engraved on the back. There is room on the back of the
bracelet to add other health concerns
and Medic Alert’s® 24-hour emergency phone number.
metal DNR bracelet is purchased, for a cost, through
(PDF, 2 MB)
is also an initial membership fee which is waived after the first year of
membership. Any person who chooses to have a metal bracelet but is not
able to afford the fees can apply for a sponsored membership and metal DNR bracelet. Please review the
Alert Sponsorship Program (PDF, 14 KB) for more information.
For additional information on cost and fee information for a
metal bracelet, please see the MedicAlert© website at
the patient receives either bracelet, the attending physician must counsel the
patient, the legal guardian, or the health care agent of an incapacitated
patient. The counseling session should include written information about DNR procedures and documents to be placed in the patient’s file noting
the qualifying medical condition that warrants the DNR order.
patient, patient’s guardian, or health care agent who signed the Do Not
Resuscitate (DNR) form can revoke the order by removing,
or asking someone to remove, the DNR bracelet. The attending physician must be notified as soon as possible.
To receive a DNR bracelet, complete the
DPH F-44763 (PDF, 154 KB) and take it to your primary care physician. You may then
obtain the free paper insert and bracelet from your physician, or you can
order a metal bracelet directly from Medic Alert (for a cost) using the Medic Alert Brochure.
If you are a healthcare facility or physician's office and want
to order the printed Do Not Resuscitate Insert (F-44764) materials:
- Open the
Publication Request Form F-80025A (Word, 158 KB).
- Fill in the shipping address (use street address only, no post
office boxes), date, telephone number and email address.
- Request only the quantity that you will use over the next
three to six months.
- Save the completed form to your computer and email it as an
- Please note that the Department of Health Services does not
supply the plastic bracelets, and there is no selected vendor. Each
facility can use any vendor the facility chooses.
For program information, please contact the Wisconsin Department of
Health Services, Division of Public Health, Office of Preparedness and
Emergency Health Care (OPEHC), EMS Section by calling (608) 266-1568 or via email
November 17, 2014