What Is a POLST Form? POLST vs. DNR vs. Living Will

A POLST form is a portable medical order, signed by a clinician, that tells paramedics and other health care providers which life-sustaining treatments a seriously ill or very frail person wants or doesn't want if they can't speak for themselves. It covers CPR, how aggressive treatment should be (including whether to go to the hospital), and tube feeding. A DNR only covers CPR. A living will is a legal document that describes wishes in general terms, and emergency crews generally can't act on it the way they act on a POLST.

That's the quick answer. The rest of this guide covers what's actually on the form, what your state calls it, who can sign it, how it fits with the papers your parent may already have, and the practical part: where it lives so someone can find it in the middle of the night.

What a POLST form is

The National POLST organization describes the form as a portable medical order for patients who have a progressing serious illness or frailty due to aging. It tells providers what the patient wants if they become unresponsive, and what their goals of care are given their current condition. Having one is optional.

The name used to stand for "Physician Orders for Life-Sustaining Treatment." According to National POLST's FAQ, POLST is no longer an acronym nationally; it now just stands for "portable medical orders." That fits reality, since in some states physicians aren't the only ones who can sign it. In California, for example, nurse practitioners and physician assistants can sign too.

The reason it exists is blunt. When emergency responders arrive and have no clear instructions, the standard of care is to try everything: CPR, a breathing tube, a fast trip to the ICU. National POLST says that for seriously ill and frail people, those treatments can be painful and unlikely to help. A POLST turns your parent's choices into an order the crew is trained to follow.

Who a POLST is for (and who it isn't)

A POLST is meant for people who are very sick or very frail. National POLST is direct about this: if you are healthy, you don't need one, and an advance directive is the right planning tool. Its FAQ adds that some states prohibit providers from signing a POLST for a healthy patient, and that a doctor may decline to sign one if they don't know the patient well.

New York's Department of Health gives a useful picture of who should at least have the conversation. Its MOLST FAQ suggests clinicians consider it for patients who:

• Live in a long-term care facility, or need long-term care at home or in assisted living
• Have one or more advanced chronic conditions, or a new diagnosis with a poor prognosis
• Have had two or more unplanned hospital admissions in the last 12 months, along with increasing frailty, declining function, weight loss or little social support
• Might die within the next year
• Want to avoid, or to receive, life-sustaining treatment

If your mom has been in and out of the hospital with heart failure this year, that list is worth reading twice.

What's actually on a POLST form

National POLST describes three core decisions on the form:

1. CPR or no CPR, if the heart or breathing stops.
2. The level of treatment: full or intensive, selective, or comfort focused. This is where the form says whether your parent wants to go to the hospital or stay where they are, and whether they'd accept intensive care and a breathing machine.
3. Medically assisted nutrition, typically no artificial feeding, temporary artificial feeding, or a surgically implanted feeding tube.

State forms differ in layout and wording, so your parent's may look different, but those are the big questions.

Two details the forms themselves rarely spell out for families:

• A POLST is not automatically a "do not treat" order. National POLST gives the example of Tom, 75, just diagnosed with dementia and otherwise in good health, who uses his POLST to ask for CPR and full treatment for now. The form records whatever the person chooses, including "do everything."
• Blank sections mean full treatment. The Coalition for Compassionate Care of California's POLST FAQ for consumers says providers will assume your parent wants full treatment for any section left blank. New York's MOLST guidance says the same thing. If your dad was unsure about tube feeding and that section was skipped, he hasn't refused it.

National POLST also says the form isn't only for emergencies. The goals of care on it guide day-to-day decisions too, such as antibiotics and artificial nutrition.

POLST vs. DNR vs. living will vs. advance directive

This is where most families get tangled, because the documents sound alike and often sit in the same folder. Here's how they compare, drawing on National POLST, MedlinePlus and state health departments cited below.

POLST vs. DNR

A DNR is narrow. MedlinePlus defines a DNR order as a medical order written by a health care provider telling providers not to do CPR if breathing or the heart stops. It says the order is specific about CPR and doesn't include instructions for other treatments, such as pain medicine or nutrition.

A POLST can include a no-CPR order, but it goes further: it also covers the level of treatment and feeding tubes, and it can just as easily say "yes, attempt CPR." CaringInfo, from the National Alliance for Care at Home, puts it this way: a POLST has the option of specifying DNR but also makes provision for other treatment choices.

There's a second wrinkle that trips people up: not every DNR works at home. Nevada's health department explains that there are two types of DNR, one for patients in a health care facility and one for patients outside it. In Nevada, a regular DNR is effective only during a stay in a hospital or nursing home; outside a facility, a separate out-of-hospital or EMS DNR is required. So the DNR in your dad's hospital chart may not travel home with him. Ask before discharge whether he needs an out-of-hospital DNR, a POLST, or both.

The rules on who can sign also differ. The California FAQ says a prehospital DNR there must be signed by a physician and can't be signed by a nurse practitioner or physician assistant, while a California POLST can be signed by any of the three. In New York, the state says the MOLST is the only authorized form for documenting both nonhospital DNR and Do Not Intubate orders.

POLST vs. living will

A living will describes the care your parent does or doesn't want. MedlinePlus says a living will can cover wishes about CPR, tube feeding and extended time on a breathing machine, that each state has its own laws about them, and that you can't name a decision-maker in a living will.

The difference that matters on a 911 call: a living will isn't a medical order. National POLST's guidance for clinicians says legal documents like advance directives, living wills and health care powers of attorney are not orders that EMS providers can follow. Nevada's health department says the same, and New York's MOLST FAQ says living wills and health care proxies typically contain more general instructions and can't be followed by EMS in an emergency.

So if your mom has a living will that says "no machines" but no POLST or out-of-hospital DNR, paramedics will generally treat her fully and get her to the hospital. The living will matters once the hospital team is making decisions.

POLST vs. advance directive

"Advance directive" is the umbrella term for the legal documents: the living will and the health care power of attorney (also called a health care proxy). National POLST's comparison chart on its About the POLST Form page lays out the differences:

• An advance directive is for all adults. A POLST is for people who are seriously ill or frail, at any age.
• Your parent fills out an advance directive. A health care professional fills out a POLST after talking with them.
• An advance directive can appoint a surrogate. A POLST can't.
• Emergency responders can't use an advance directive. They can use a POLST.

Timing is different too. A health care proxy only kicks in once your parent loses the ability to make decisions. New York's health department says the MOLST, by contrast, applies as soon as the patient consents and a clinician signs it. In practice, if your parent can still talk during an emergency, the crew will ask them.

Does a POLST replace a living will?

No. National POLST says they support each other, and that for seriously ill patients it's best to have both an advance directive and a POLST and confirm they agree. Your parent still needs a health care power of attorney to name the person who speaks for them. The POLST only records specific treatment orders.

What your parent's state calls it

POLST programs are run by each state, not by National POLST, and the names vary. The National POLST state directory lists every state and the District of Columbia. A few examples from that directory:

Names change. Massachusetts is a good example right now: the state's Executive Office of Aging and Independence says Massachusetts is moving from its MOLST form to POLST, that MOLST remains the form to use until the transition in 2027, and that existing MOLST forms will still be honored afterward. If your parent's form has an older name, it isn't automatically void. Check the state program's page before assuming anything.

Who can sign it

This varies by state. National POLST says the provider must sign for the form to be valid, and that most states, plus the National POLST Form, also require the patient or the patient's surrogate to sign. Some state examples:

• California: a physician, nurse practitioner or physician assistant, plus the patient or their legally recognized decision-maker, according to the California FAQ.
• New York: a New York licensed physician, nurse practitioner or physician assistant, or a physician licensed in a border state (Pennsylvania, New Jersey, Connecticut, Massachusetts or Vermont), according to the state health department.
• Massachusetts: the signing clinician (physician, nurse practitioner or physician assistant) and the patient, according to the state's MOLST page.

If your parent can no longer communicate, many states let the health care agent or other legal decision-maker take part. The California FAQ says a provider can complete the form based on the family's understanding of their loved one's wishes, with the legally recognized decision-maker signing on the patient's behalf. Your state's rules on who counts as that decision-maker may differ, which is one more reason to have the health care proxy done first.

How to get one for your parent

You don't download a POLST and fill it out at the kitchen table. National POLST says patients shouldn't be handed the form to complete on their own, and that it should never be completed without a conversation about diagnosis, prognosis, treatment options and goals of care. Many states post their form online so you can read it ahead of time, but the signed version comes from your parent's clinician.

A practical way to approach it:

1. Read your state's form first. Find it through the state directory so the appointment isn't the first time anyone sees the questions.
2. Ask for a dedicated visit. Tell the office you want to talk about a POLST (or MOLST, or whatever your state calls it). It's a real conversation, not something to squeeze into the last two minutes of a blood pressure check.
3. Bring the health care agent. Massachusetts recommends including the health care agent whenever possible, and National POLST suggests the same.
4. Bring the existing papers. The living will and health care power of attorney, so the doctor can check that everything lines up.
5. Ask the questions the form can't answer. What would CPR likely mean for your parent, given their condition? What does "selective treatment" look like in real life for them?
6. Leave with copies. National POLST says the provider keeps a copy in the medical record and your parent keeps the original.

Where to keep a POLST form

A POLST nobody can find is just paper. National POLST's guide to managing the form says:

• At home, keep the original in a visible place caregivers know about. Its FAQ names the refrigerator, beside the bed, or the medicine cabinet, because emergency personnel look there.
• Away from home, carry a copy in a wallet or purse near the ID. A copy stored on a phone can help too.
• In a hospital or nursing home, the form goes in the chart, and the original goes with your parent when they move from one setting to another.
• Tell people. Crews are trained to look, but family and caregivers who can point to it make the job much easier.

National POLST says faxed and photocopied forms are valid in almost all states. Some states use bright colored paper so the form stands out; New York says its MOLST is ideally printed on bright pink paper, and California's FAQ says its pink form is valid on any color paper, including scans and PDFs.

Some states add backup systems. National POLST notes that some states have electronic POLST registries or bracelets that alert responders. The California FAQ lists four state-approved providers of DNR/POLST bracelets and medallions, and points out that EMS may or may not check a pocket or purse.

If your parent already has a Vial of Life or File of Life kit, our Vial of Life guide explains how to note the POLST's location on that form. For the hospital, put a copy in the bag from our list of what to bring to the ER for an elderly parent.

Reviewing, changing or voiding a POLST

National POLST recommends reviewing the form at least once a year, any time your parent's condition changes, and when they move. A few rules from the same page are worth knowing before you need them:

• You can't edit it. Because it's a signed medical order, crossing out a box and writing in a new choice doesn't work. To change it, your parent tells the provider and signs a new form.
• Your parent can void it on their own. Draw a line across it and write "VOID" in large letters, or destroy it. Then tell the provider, so the medical record (and the state registry, if there is one) gets updated.
• Collect the copies. If the old version is taped inside a kitchen cabinet and photographed on three siblings' phones, retire all of them.
• Moving or traveling? National POLST says a form will most likely be honored in another state, with some limits. It recommends bringing both the POLST and the advance directive when traveling, and getting a new form on the new state's version after a move.

Frequently asked questions

Is a POLST the same as a DNR?

No. A DNR only covers CPR. A POLST covers CPR plus the overall level of treatment, hospital transfer and tube feeding, and it can say yes to CPR as well as no. A POLST with "no CPR" checked works like a DNR for that one question.

Do paramedics follow a living will?

Generally, no. National POLST and several state health departments say living wills and health care proxies aren't orders EMS can follow in an emergency. A POLST or a valid out-of-hospital DNR is what tells a crew to hold back on CPR or other treatment.

Who should have a POLST form?

People who are seriously ill or have advanced frailty, at any age. National POLST says healthy people don't need one and should have an advance directive instead. Your parent's doctor can tell you whether their condition fits your state's rules.

Does a POLST form need to be notarized?

National POLST describes it as a medical order signed by a clinician, and in most states by the patient or their decision-maker as well; the official sources we checked don't mention a notary for the POLST itself, but read your state's form to be sure. Living wills and health care powers of attorney follow state law on witnesses and notaries, so check your state's rules for those separately.

Is a POLST valid in another state?

Most likely, according to National POLST, but there are limits. Bring the POLST and advance directive when your parent travels, and after a move, ask their new doctor to complete the new state's form.

Keeping all of it in one place

A POLST is one page, but it's tangled up with several others: the health care proxy that names who decides, the living will, maybe a DNR from a past hospital stay, plus the medication list and doctor contacts a crew will ask about. Our guide to important documents for aging parents walks through each one and where the original should live.

You can track all of this yourself with a folder and the sections above. Or Emergency Binder Now can do the organizing: about 25 minutes of guided questions produces a printable emergency binder for your parent, with a page recording whether a POLST, DNR, living will and health care proxy exist and exactly where each one is kept, a one-page Emergency Information Sheet for paramedics and the ER, and a list of what's still missing. You can see a sample binder first.

This article is general information, not legal or medical advice. POLST, DNR and advance directive rules differ by state. Talk with your parent's doctor about whether a POLST fits their situation, and with an attorney in their state about advance directives.