Will paramedics follow my DNR?

Only if it is on the state-recognised form and physically present at the scene. EMS follows standard protocols (full resuscitation) unless they see a valid POLST/DNR. Living wills, healthcare POAs, and verbal statements from family generally do NOT stop EMS from attempting resuscitation. The state-specific brightly-coloured POLST form is the standard.

Can a healthy person have a DNR?

Generally not appropriate. The POLST is designed for patients with advanced illness or frailty where the orders match the medical situation. A healthy 30-year-old with a DNR creates ethical and clinical conflicts — providers may struggle with whether to follow the order in a sudden, reversible emergency (drug overdose, drowning, vehicle accident). Healthy patients who want to express preferences should use a living will / advance directive instead.

Does a POLST in one state work in another?

Most states honour out-of-state POLSTs but the local form is much more reliably followed. If you spend significant time in two states, execute both states' forms. The National POLST Coalition is working toward greater portability but state laws still vary significantly.

How do I revoke a DNR?

Verbally to any provider or in writing. The patient can revoke at any time, in any manner that communicates intent to revoke. After revocation, destroy or recover all copies, and notify the primary-care physician, hospital, EMS, and any nursing facility that has a copy on file. Many states also have electronic POLST registries that need updating.

Who signs the POLST — patient or doctor?

Both. The patient (or healthcare agent on behalf of an incapacitated patient) signs, AND the physician (or in some states, NP/PA) signs as the medical order. A patient signature alone is not enough — and a physician signature alone is not legally valid without patient/agent consent. Both signatures are required for the order to be effective.

Advance Directive — Do Not Resuscitate (DNR / POLST)

DNR / POLST-style directive — specific medical order to refuse CPR and other life-sustaining treatments.

Customise

Patient — full name

Patient — DOB

Patient — address

State (DNR forms are state-specific)

CPR preference if pulseless / not breathing

Medical interventions if breathing / has pulse

Artificial nutrition (feeding tube)

Antibiotics

This directive was discussed with

Signing physician — name

Signing physician — phone

Healthcare agent (or "self")

Signing date

Live preview

ADVANCE DIRECTIVE — PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT
(DNR / POLST / MOLST — state form names vary)

═══════════════════════════════════════════════════════════════════════

⚠️  THIS IS A MEDICAL ORDER. EMS, HOSPITALS, AND NURSING HOMES MUST FOLLOW
    IT. UNLIKE A LIVING WILL (PATIENT PREFERENCES), THIS IS A SIGNED
    PHYSICIAN ORDER WITH IMMEDIATE EFFECT.

═══════════════════════════════════════════════════════════════════════

PATIENT

Name:                    Jordan Alex Taylor
DOB:                     March 14, 1948
Address:                 482 Elm Street, Apt 3B, Portland, OR 97214
Governing form / state:  Oregon (POLST)

═══════════════════════════════════════════════════════════════════════

SECTION A — CARDIOPULMONARY RESUSCITATION (CPR)

If patient has NO PULSE AND IS NOT BREATHING:

   ► DO NOT ATTEMPT RESUSCITATION (DNAR / DNR)

═══════════════════════════════════════════════════════════════════════

SECTION B — MEDICAL INTERVENTIONS

If patient HAS A PULSE AND IS BREATHING (any condition other than full arrest):

   ► Selective treatment — comfort + medical interventions, but no intubation

═══════════════════════════════════════════════════════════════════════

SECTION C — ARTIFICIAL NUTRITION

   ► No artificial nutrition by tube

═══════════════════════════════════════════════════════════════════════

SECTION D — ANTIBIOTICS

   ► Use antibiotics if life can be prolonged with reasonable quality

═══════════════════════════════════════════════════════════════════════

DISCUSSION AND DECISION-MAKING

This directive was discussed with:
Dr. Lin Chen (primary care), Sam Taylor (healthcare agent), and family on 2026-04-22.

The directive reflects the patient's informed wishes (or, if patient lacks capacity, the wishes expressed in the patient's prior advance directive or by the legally-authorised healthcare agent).

═══════════════════════════════════════════════════════════════════════

PHYSICIAN ORDER

Patient signature:


_______________________________            Date: ____________________
Jordan Alex Taylor (or healthcare agent on patient's behalf)


Physician signature:


_______________________________            Date: ____________________
Dr. Lin Chen, MD
Phone: +1 503 555 0411
License #: ____________________

Healthcare agent (if signing for incapacitated patient):
Sam Taylor (sister) — see Healthcare POA on file

═══════════════════════════════════════════════════════════════════════

DOCUMENT HANDLING

  • Original form (often coloured paper) stays with the patient.
  • Copies posted at home: refrigerator, bedroom door (paramedics check these locations).
  • Copy in patient's wallet.
  • Copy on file with primary-care physician, hospital, EMS provider (where state law permits).
  • Many states have an electronic registry — check whether your state requires registry filing.

This directive remains in effect until revoked. Patient may revoke at any time, in any manner that communicates intent to revoke.

═══════════════════════════════════════════════════════════════════════

Signed: May 4, 2026

About this template

A DNR / POLST / MOLST is fundamentally different from a living will or advance directive. Where a living will states the patient's preferences (and the healthcare agent and treating providers must interpret those preferences), a POLST is a SIGNED MEDICAL ORDER on a state-prescribed form, immediately actionable by EMS, hospitals, and nursing homes without further interpretation. Paramedics arriving at a cardiac arrest in a home WILL attempt full resuscitation unless they see a valid state DNR/POLST form — a living will alone does not override standard EMS protocol. The POLST form (or its state-specific equivalent — POLST in Oregon and California; MOLST in New York and Massachusetts; MOST, POST, COLST elsewhere) typically appears on bright-coloured paper (often pink, green, or yellow) and is designed for immediate visual identification. The form is most appropriate for patients with serious illness or advanced frailty whose providers would not be surprised if they died within the next year. Healthy patients who want to express end-of-life preferences should use a living will / advance directive instead — POLST for the relatively-healthy can be inappropriate. Both documents work together: the advance directive expresses preferences; the POLST converts those preferences into actionable orders when the time comes. The POLST is portable across care settings (home, hospital, nursing facility, hospice) and survives transfer between providers. Review the POLST whenever the patient's condition or preferences change significantly.

When to use it

Patient with serious illness whose providers would not be surprised if they died within a year.
Advanced frailty in older adults with multiple chronic conditions.
After diagnosis of terminal illness with months-to-year prognosis.
Transition to hospice or palliative care.
Long-term-care facility admission (some require POLST).

What to include

CPR preference (Section A).
Medical-intervention level (Section B).
Artificial nutrition preference (Section C).
Antibiotic preference (Section D).
Documentation of discussion with patient/family/agent.
Patient AND physician signatures (both required).

Frequently asked

A living will is the patient's personal document expressing preferences; a POLST is a physician-signed medical order with immediate effect on EMS, hospitals, and nursing homes. Living wills require interpretation; POLSTs are followed directly. Most patients should have BOTH — the advance directive expresses preferences, and the POLST converts those preferences into actionable orders for those whose health condition makes the orders appropriate now.

⚠ Legal disclaimer. POLST/MOLST/DNR forms are state-specific medical orders. Use your state's official form (Oregon POLST, California POLST, New York MOLST, Massachusetts MOLST, etc.) — generic forms are typically NOT honoured by EMS or hospitals. Both patient (or healthcare agent) AND physician signatures are required. Discuss with your primary-care provider whether a POLST is appropriate for your medical situation; for healthy patients, a living will / advance directive is generally more appropriate. State Department of Health websites provide the official current form.