Wisconsin DNR Form and Bracelet: How the Out-of-Hospital DNR Order Works

An in-hospital "do not resuscitate" note in your chart stops at the hospital's front door. If paramedics are called to your home, a hospice house, or a car accident scene, they cannot honor a chart order they have never seen — Wisconsin EMS protocol is to attempt CPR unless presented with a valid state DNR order and its matching bracelet. For anyone with a terminal illness or a settled wish to decline resuscitation, the out-of-hospital DNR is the document that actually travels with you.

Here is how the Wisconsin system works, from the physician's signature to the bracelet on your wrist.

The Form: F-44763

Wisconsin's DNR order is a standardized Department of Health Services form — F-44763 — governed by Wis. Stat. Chapter 154. Key points:

• Only an attending physician can sign it. Unlike your living will or health care POA, which you execute yourself, a DNR is a medical order. It requires your physician's clinical judgment that the order is appropriate, and it follows a conversation (and ideally documented consent) with you or your health care agent.
• It covers CPR only. A DNR directs responders to withhold cardiopulmonary resuscitation — chest compressions, defibrillation, airway interventions. It does not limit comfort care, pain medication, oxygen, or any other treatment. "Do not resuscitate" never means "do not treat."
• It is effective immediately and across settings. Once signed, it is valid at home, in transport, at a nursing facility, or in the emergency department until revoked or replaced.

If your physician's office does not stock the form, the DHS EMS office publishes it, and hospice agencies and hospital discharge planners handle the paperwork routinely.

Why the Bracelet Matters

The signed form alone is not enough for EMS. Wisconsin law requires responders to see a state-approved DNR bracelet before withholding resuscitation. Two versions qualify:

• The standard plastic bracelet issued with form F-44763 (the insert version)
• A metal bracelet from a state-approved vendor (StickyJ is the long-standing supplier), which is more practical for permanent, everyday wear

The bracelet is what a paramedic can check in seconds during a cardiac arrest. No bracelet, and responders are legally required to attempt resuscitation even if a family member waves the paper form. Families are often shocked by this — keep the original form accessible (many people tape it to the refrigerator, a location EMS crews know to check) and wear the bracelet at all times.

DNR vs Living Will vs POLST

These three get confused constantly:

• Living will (Declaration to Physicians, Ch. 154): your own written statement about life-sustaining treatment, active only after two physicians certify a terminal condition or persistent vegetative state. It does not instruct EMS.
• DNR order: a physician-signed order covering one intervention — CPR — effective everywhere, immediately.
• POLST (Physician Orders for Life-Sustaining Treatment): a broader clinician-completed order set used during serious illness, translating your advance directive into specific, actionable orders across care settings.

Most people planning ahead need the living will and health care POA first; the DNR becomes relevant when resuscitation itself is no longer wanted or medically appropriate — typically with advanced illness or frailty. Your health care agent can consent to a DNR on your behalf if your Chapter 155 POA grants that authority, which is one more reason to execute the Wisconsin advance directive documents before a crisis.

Revoking or Changing a DNR

You (or your agent) can revoke the order at any time — verbally to a provider, by destroying the form and bracelet, or in writing. Cut off and discard the bracelet; tell your physician, hospice team, and any facility holding the order so the revocation is noted in every record. If you later want the order reinstated, your physician signs a new F-44763 and a new bracelet is issued.

Practical Steps to Get One

1. Talk with your attending physician. If you are under hospice care, the hospice physician handles it; otherwise your primary doctor does.
2. Sign where indicated (or your agent signs), the physician signs, and the form is dated.
3. Put on the bracelet immediately — plastic from the form packet, or order the metal version for durability.
4. Post the original where EMS will look — refrigerator door or above your bed are the standard spots.
5. Give copies to your agent, your facility (if in a nursing home), and your local EMS service if they accept advance registration.

Bottom Line

The Wisconsin DNR is a small document with an unforgiving execution requirement: physician signature on form F-44763 plus the approved bracelet, or paramedics must resuscitate. It belongs alongside — not instead of — your living will and health care POA. The Wisconsin Advance Directive & Living Will Kit includes the full directive system plus a key-contacts log and storage checklist so your DNR, declaration, and POA stay consistent and findable when minutes matter.

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