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Click ‘Get Form’ to open the DHS DNR in the editor.
Begin by entering your name in the designated field at the top of the form. This identifies you as the individual requesting limited health care.
In the next section, review and understand your rights regarding health care. Ensure you are comfortable with the implications of a do-not-resuscitate order.
Sign and date the form where indicated. If applicable, have your representative sign as well, ensuring they meet legal requirements.
Complete the witness section by having two witnesses sign and provide their addresses, confirming that they observed your signature.
If a physician's certification is required, ensure that it is filled out correctly by an attending physician who can attest to your wishes.
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Wis. Admin. Code Department of Health Services DHS 125.04
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