DNR Order vs. POLST Form: What’s the Difference?

Living wills and powers of attorney for health care are important for recording your health care wishes, but they might not be available in an emergency. To help in these situations, you can use two other documents: a Do Not Resuscitate (DNR) order or a Physician Order for Life-Sustaining Treatment (POLST) form. This article explains what these orders are, how they work, and the main differences between them.

What Is a DNR Order? (Do Not Resuscitate)

A DNR order instructs emergency medical personnel not to administer cardiopulmonary resuscitation (CPR). These orders apply both in hospitals and outside medical facilities. Some states use alternative names such as DNAR (Do Not Attempt Resuscitation), AND (Allow Natural Death), No Code Order, or Comfort One. We use "DNR order" because it's the most common term.

You might want a DNR order if you are close to death from a terminal illness, have a high risk of heart or breathing failure, or are certain you do not want CPR. In most states, any adult can get a DNR order.

Emergency teams have to act fast in a crisis and usually do not have time to check your health care directives or living will. If they do not know your wishes, they must provide all life-saving measures. But if they see a valid DNR order, often shown by a clear bracelet, anklet, or necklace, they will not give CPR.

If you have a DNR order, you will not get chest compressions, electric shocks to the chest, breathing tubes, artificial ventilation, or cardiac drugs.

See below for information on how to set up a DNR order.

What Is a POLST Form? (Physician Orders for Life-Sustaining Treatment)

Almost every state has adopted the POLST form. It’s a medical order that resembles a DNR order but includes several key differences. This form typically goes by the name Physician Orders for Life-Sustaining Treatment (POLST), although some states use other names, including Physician Orders for Scope of Treatment (POST), Clinician Orders for Life-Sustaining Treatment (COLST), Medical Orders for Life-Sustaining Treatment (MOLST), Medical Orders for Scope of Treatment (MOST), or Transportable Physician Orders for Patient Preferences (TPOPP).

A POLST form addresses several important treatment decisions, including whether to perform CPR, what level of medical intervention you want, such as hospitalization, intubation, or comfort measures only, and your preferences regarding antibiotics and artificially administered nutrition and hydration. These orders take effect when you are unable to communicate your wishes yourself, ensuring that health care providers understand and honor your treatment preferences during a medical crisis.

A POLST form is added to your medical records and moves with you between health care facilities. It tells all your health care providers, including emergency staff, what treatments you want. Most states print POLST forms on bright paper, usually pink or green, so they are easy to spot.

To find out how to make a POLST, see below.

What’s the Difference Between DNR Orders and POLST Forms?

DNR orders and POLST forms are legal medical orders that need a doctor or other authorized provider’s signature. In an emergency, EMTs and doctors must follow these orders, and there are serious legal consequences if they do not. These forms differ from advance directives, such as living wills, that you can complete on your own.

Both DNR orders and POLST forms indicate whether emergency staff should perform CPR. But a POLST form covers more, such as instructions on intubation, antibiotics, and the administration of nutrition or hydration. A DNR order addresses CPR only if your heart or breathing stops, while a POLST form covers a wider range of emergency care.

Another difference is where these documents are kept. A POLST form is part of your medical records and moves with you between health care facilities, printed on bright paper so it stands out. A DNR order should be kept with you or nearby, along with a bracelet or similar item to alert emergency staff. In summary, a POLST stays in the medical system, while a DNR stays with you.

Both documents help medical staff quickly understand your wishes in an emergency, but they do not replace a full health care directive or living will. These orders work best as part of a complete advance care plan that also names your health care agent or proxy and explains your overall treatment wishes.

How to Make a DNR Order or POLST Form

You need a health care provider’s signature to make a DNR order or POLST form valid, so you cannot fill them out by yourself. Here is how you can work with your doctor or another authorized provider to create a DNR or POLST.

DNR Order. If you want a DNR order, talk with your doctor. In most states, a physician's signature is required to make the DNR valid, and your doctor will need to obtain and complete the necessary paperwork. The DNR must be signed by you (or by your legally recognized health care decision maker if you're unable to make or communicate informed decisions) and by your physician, who affirms that you have given informed consent to the DNR instruction.

If your doctor does not have the form or information you need, contact your state’s Health Department and ask for the Division of Emergency Medical Services. They can help you find the right forms and approved providers for DNR bracelets or medallions, which help emergency staff quickly see your DNR status.

POLST Form. If you want a POLST, talk to your health care provider to see if it is right for you. When you go to a hospital, hospice, or nursing home, staff may ask if you want to fill out a POLST form. You can also ask for one at any time.

Does a POLST need a doctor’s signature? Yes. To be valid, both you (or your legal health care decision maker) and a doctor, nurse practitioner, or physician assistant must sign the form. Before signing, your provider should discuss your health, treatment goals, and the risks and benefits of each option with you. This helps make sure the form aligns with your wishes.

If you want to look at a blank POLST form before filling it out with your provider, you can find your state’s form online at the National POLST website or your state’s health department. Remember, making a POLST is voluntary. No one can make you complete one, even if a facility includes it in its admission forms.

What to Do After Making a DNR Order or POLST Form

After you have a DNR order or POLST form, follow these steps to make sure your wishes are followed:

Tell Your Family and Caretakers. Talk with your family, caretakers, and anyone who might be with you in an emergency. Make sure they know what your orders mean and can speak up for your wishes. For DNR orders, let them know where you keep the form at home. For POLST forms, tell them it is in your medical records and they can ask medical staff to find it if needed.

Share Copies. For DNR orders, give copies to all your health care providers, including your primary care doctor, specialists, and any places where you get care. If you have a health care proxy or power of attorney, give them a copy too. For POLST forms, you do not need to hand out copies; they are part of your medical records and move with you between facilities.

Keep Forms Accessible. For DNR orders at home, put the form somewhere obvious and easy to reach, like by your bed, on your fridge, in your wallet, or in your suitcase when you travel. Even if you wear a DNR bracelet or necklace, keep the form handy. If the DNR form is not easy to find or has been changed, CPR will probably be given.

For POLST forms, they remain in your medical records as you move between health care facilities. If you get care at home through hospice or home health, ask to keep a copy of your POLST in a visible spot at home so emergency staff can see it right away. The bright paper is meant to stand out for medical workers.

Review and Update Regularly. Your medical condition and treatment preferences may change over time. Review your DNR order and POLST form periodically with your health care provider, especially after any significant change in your health status. If you need to make changes, you cannot simply edit these forms; you must revoke the existing form and complete a new one with your provider’s signature.

Know How to Cancel. You can revoke a DNR order or POLST form at any time if you are able to make decisions. To cancel, it is best to completely destroy the form. Most importantly, tell your health care provider right away so they can remove it from your records. If you do not tell your providers, the old orders might still be used in an emergency.

More Information About Advance Health Care Planning

DNR orders and POLST forms are helpful tools that work with your health care directives. They help emergency staff quickly know and follow your wishes in a crisis. By making these documents with your doctor and keeping them up to date, you can help make sure you get the care you want when it matters most.

For more information, see the following articles:

• Power of Attorney for Health Care: What Powers Can You Grant?
• Expressing Organ Donation Wishes in Your Health Care Directive
• Witness and Notary Requirements for Advance Directives
• Storing, Sharing, or Revoking Your Advance Directive

You can learn more about making health care directives in WillMaker’s Legal Manual.