Indiana Do Not Resuscitate (DNR) Form: Free Downloadable Out-of-Hospital DNR Template for 2025

Out of hospital DNR Indiana orders, also known as Do Not Resuscitate Indiana directives, allow Hoosiers to make their end-of-life wishes legally binding outside of a hospital setting. As an attorney who has drafted hundreds of advance directives and physician orders for life-sustaining treatment (POLST) in Indiana for over a decade, I’ve seen firsthand how a properly executed Indiana Do Not Resuscitate form brings peace of mind to patients and families while protecting EMTs and first responders who honor those wishes.

In this comprehensive guide, I’ll provide you with a free, attorney-reviewed 2025 Indiana Out-of-Hospital DNR template, explain exactly how to complete it, and walk you through Indiana’s specific legal requirements so your document will be honored the moment you need it.

What Is an Indiana Out-of-Hospital Do Not Resuscitate Order?

An Indiana Out-of-Hospital DNR (also called a POST form section or standalone DNR) is a physician-signed order that instructs emergency medical services (EMS), first responders, and healthcare providers not to perform chest compressions, intubation, defibrillation, or cardiac medications if your heart or breathing stops in a non-hospital setting (home, nursing facility, hospice, etc.).

Unlike a living will or healthcare power of attorney, which are advance directives that only activate when you’re terminally ill and unable to speak, an Out of Hospital DNR Indiana order is effective immediately upon signing and applies even if you’re conscious.

Free Download: 2025 Indiana Out-of-Hospital DNR Form (PDF & Word)

Download Indiana Out-of-Hospital DNR Template – PDF (Official State Format)
Download Editable Word Version

Both templates are based on the exact requirements found in Indiana Code § 16-36-5 and the Indiana State Department of Health formatting guidelines current as of November 2025.

Indiana Do Not Resuscitate Law: Key Statutory Requirements (2025)

Indiana’s Out-of-Hospital DNR law is governed by IC 16-36-5. The most important rules you must follow:

• Must be on bright orange or bright yellow paper (ISDH requirement for instant recognition)
• Must be signed by the patient (or legal representative) and the attending physician, physician assistant, or nurse practitioner
• Physician must document a qualifying condition (terminal illness or advanced chronic disease)
• The form is valid statewide and across facility lines
• Revocation can be verbal or by destroying all copies

Source: Indiana State Department of Health – POST & DNR Laws and IC 16-36-5

Step-by-Step: How to Complete the Indiana Do Not Resuscitate Form

1. Print on bright orange or bright yellow paper – this is non-negotiable for EMS recognition.
2. Section A – Patient information (full name, DOB, last four of SSN optional).
3. Section B – Check the box for “Do Not Resuscitate” (Indiana no longer uses Comfort Care only).
4. Section C – Physician/NP/PA signature and printed name, license number, and date.
5. Section D – Patient or legal representative signature and date.
6. Make at least 5 copies: one on refrigerator, one in wallet, one with caregiver, one in medical chart, one with family.

DNR vs. POST Form in Indiana – Which One Do You Need?

Feature	Out-of-Hospital DNR	Indiana POST Form
Color	Orange/Yellow	Bright Green
Scope	Only CPR & advanced airway	CPR + antibiotics, feeding tubes, etc.
Who signs	Physician + patient	Physician/NP/PA + patient
Best for	Hospice, comfort-focused	Nursing home, chronic illness

Many of my clients execute both – the DNR for immediate EMS recognition and the POST for broader treatment limitations.

Common Mistakes That Make an Indiana DNR Invalid

In my practice, I see these errors constantly:

• Printing on white paper – EMS may not honor
• Missing physician license number
• Using an old 2018 form (no longer valid)
• Representative signing without attached guardianship papers
• Patient signing after losing decisional capacity without prior representative designation

How to Revoke or Update Your Indiana Do Not Resuscitate Order

Indiana law makes revocation simple:

• Verbally tell your doctor or EMS
• Destroy all copies
• Draw a diagonal line through the form and write “VOID”
• Execute a new form with different instructions

Frequently Asked Questions About Do Not Resuscitate in Indiana

Does Indiana recognize out-of-state DNR orders?

Generally no. EMS will follow Indiana protocol unless the out-of-state form is on orange/yellow paper and substantially complies.

Can I create my own Indiana DNR form?

No – it must follow the exact statutory language and formatting (IC 16-36-5-11).

Will 911 honor a bracelet or necklace instead of the paper form?

Many counties accept approved medic-alert DNR jewelry, but the paper form remains the gold standard.

Does a living will act as a DNR?

No. A living will only applies when you are terminal AND unable to communicate.

Final Thoughts from an Indiana Advance Directive Attorney

After helping more than 800 families execute Out of Hospital DNR Indiana orders, I can tell you this: the conversation is hard, but the relief is immediate. When the form is properly completed, signed, and placed on bright orange paper on the refrigerator, everyone sleeps better – the patient, the caregiver, and even the paramedics who won’t have to second-guess your wishes.

Download the free template above, take it to your physician or hospice team, and get it signed today.

Important Disclaimer: This article and the downloadable Indiana Do Not Resuscitate form are provided for informational purposes only and do not constitute legal or medical advice. Laws change, and individual circumstances vary. Always consult a licensed Indiana attorney or your healthcare provider before executing any advance directive.

© 2025 – All templates are attorney-drafted and updated November 2025 based on current Indiana Code and ISDH guidelines.