Massachusetts Do Not Resuscitate (DNR) Form

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Massachusetts Do Not Resuscitate (DNR) Form

A Massachusetts do not resuscitate form is a patient’s orders to medical personnel not to perform CPR in the event of heart or breathing failure. Known as a Medical Orders for Life-Sustaining Treatment (MOLST), this form also provides staff instructions on treatment preferences regarding life-sustaining care.

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Last updated June 17th, 2025

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A Massachusetts do not resuscitate form is a patient’s orders to medical personnel not to perform CPR in the event of heart or breathing failure. Known as a Medical Orders for Life-Sustaining Treatment (MOLST), this form also provides staff instructions on treatment preferences regarding life-sustaining care.

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Note: MOLST forms should be printed on bright pink paper as EMTs are instructed to look for a document of this color before administering CPR to a patient.[1]

Signing Requirements

A DNR order will be honored if signed by the patient (or their health care agent) and a physician, nurse practitioner, or physician assistant.[2]

Do Not Resuscitate (Preview)

CC/DNR Form with Bracelet – A Comfort Care/Do Not Resuscitate Order Verification form in which a patient enters their identification and DNR details to be worn on a bracelet.

Sources

  1. MOLST Checklist
  2. MOLST and DNR Order Verification