What this guide covers
DNR, POLST & MOLSTexplains medical orders that tell emergency crews and hospitals what to do about CPR, breathing machines, and other urgent treatments when someone is seriously ill— and how patients and advocates get them right, visible, and consistent with the patient's wishes.
These are doctor's orders, not the same as a living will or naming a healthcare proxy. They are meant for people whose health is fragile enough that an emergency decision could happen soon.
Plan values first in Goals of Care Conversations, capture broad wishes in a Living Will, then use this guide when a clinician recommends a POLST-style form or a standalone DNR.
This is educational information, not medical or legal advice. Programs and form names vary by state.
What these orders are
A DNR (Do Not Resuscitate) order tells responders not to perform CPR if the heart stops or breathing stops in the situations the order covers. A POLST (Physician Orders for Life-Sustaining Treatment) or state equivalent is usually a one- or two-page bright form with multiple sections about emergency care, not only CPR.
Because they are signed medical orders, EMS and hospitals can follow them in the field without waiting for a family meeting in the driveway. That speed helps when seconds matter—but it also means errors or outdated forms have real consequences.
Advance directives plan for the future. POLST-style orders translate currentgoals into orders for today's level of illness.
POLST, MOLST & other state names
Many states use the POLST program and pink or brightly colored forms. Others use different titles: MOLST (Medical Orders for Life-Sustaining Treatment), MOST, POST (Physician Orders for Scope of Treatment), TPOPP, or state-specific outpatient DNR protocols.
The exact sections and colors differ. Use the official form and instructions for the state where the patient lives and receives care. See State Advance Directive Forms and your state health department POLST page.
Not every state has a full POLST program. Some rely on hospital DNR orders or separate EMS DNR bracelets or forms. Ask the treating clinician which order set applies locally.
Not the same as advance directives
Vs living will
A living will expresses future preferences and may not be recognized by EMS in an ambulance. A POLST/MOLSTis signed by a clinician and designed for emergency use when the patient matches the program's criteria—usually advanced serious illness or frailty.
Healthy adults doing routine planning typically complete a living will and proxy first, not a POLST.
Vs healthcare proxy
The healthcare proxy names who decides when the patient cannot. POLST-style orders say what to do in defined emergencies even before the proxy arrives. Proxy and orders should agree. See Healthcare Power of Attorney / Proxy.
Vs hospital code status
In hospitals, you may hear full code, DNR, DNI (do not intubate), orcomfort measures. Those are chart orders for that facility stay. A POLST is meant to travel with the patient across settings when valid in the state.
At admission, ask whether the hospital code status matches the POLST. Mismatches cause confusion in the ICU.
Who usually needs a POLST-style form
POLST programs target people with serious advancing illness or advanced frailty where clinicians would not be surprised if the patient died within a year—or where CPR would likely cause harm without meaningful recovery.
Examples often include advanced heart failure, COPD with frequent hospitalizations, widespread cancer, advanced dementia, or late-stage organ failure. A fit 40-year-old doing general estate planning usually does not need a POLST yet.
The clinician judges whether the form is appropriate. Advocates can request a goals-of-care visit to discuss whether orders are needed now.
What the form usually orders
Sections vary by state but commonly address CPR if the heart stops, medical interventions such as intubation and ICU-level care versus comfort-focused treatment, antibiotics for infections, artificial nutrition by tube, and sometimes hospitalization versus treat-at-home instructions.
Each line is a medical order, not a vague preference. Read every box with the clinician. Ask what each choice means for a 911 call at home versus a planned hospital stay.
Some forms use letter codes patients wear on bracelets. Confirm whether your state requires the original form, a bracelet, or both for EMS.
DNR alone vs full POLST
A standalone DNR may be enough when the only urgent question is CPR, but serious illness often involves more than chest compressions. A full POLST-style form addresses ventilation and other interventions in one place.
Hospitals may issue their own DNR order during an admission. That order may expire at discharge unless replaced by an outpatient POLST or state EMS DNR process. Ask at discharge what travels home.
How EMS & hospitals use them
In a home emergency, paramedics look for the form on the refrigerator, a bracelet, or paperwork the family hands them. If they see a valid DNR or POLST section refusing CPR, they withhold CPR in covered situations even if family is shouting otherwise— unless the order is invalid, unclear, or the patient does not match program rules.
Hospitals use orders to guide code teams and ICU paths. Orders do not block routine comfort care—pain medicine, oxygen for breathlessness, or treatment the patient wants when alert and capable of choosing.
When the patient can participate, same-day choices may update orders after a goals-of-care talk even if an old POLST exists.
Get the form completed correctly
Clinician signature required
Patients and families do not self-sign POLST forms into legal effect. A physician, nurse practitioner, or physician assistant (per state rules) completes the form after discussion with the patient or authorized decision-maker.
If the patient lacks capacity, the healthcare proxy should participate and the signature rules for surrogates in your state apply.
Goals-of-care talk first
The form should reflect a real conversation, not a checkbox rushed in a discharge lobby. Ask how each section matches what the patient would want if they worsened tonight.
For structured talks, see Goals of Care Conversations and Palliative Care.
Display at home & share copies
Place the original or a clearly marked copy where EMS is trained to look—often the refrigerator. Give copies to family, home health, hospice, the nursing facility, and the primary clinician. Scan into the hospital chart before the next admission.
Update, revoke & fix conflicts
Cross out and replace with a new signed form when goals change—do not scribble unclear edits. Date matters. After a major improvement or a new treatment plan, revisit whether DNR sections still fit.
If a living will from years ago says "full treatment" but a new POLST says comfort-focused care, clinicians follow the valid medical order for emergencies while the proxy clarifies long-term plans. Fix contradictions in writing as soon as the patient can participate.
Destroy outdated copies so paramedics do not find an old DNR on the fridge and a new full-code POLST in the wallet.
What advocates should do
Before an emergency
Ask the clinician whether POLST is appropriate. Schedule the signing visit. Confirm bracelet needs. File copies in the caregiver folder and upload to the portal if offered.
Talk with family so they are not surprised at the door when EMS follows the order. Disagreement should be resolved in a meeting, not during chest compressions.
In the hospital or EMS call
Hand responders the form immediately. State the patient's name and that a POLST or DNR exists. One calm spokesperson helps.
On admission, reconcile POLST with hospital code status. After discharge, confirm what order applies at home.
If family conflict erupts, see Family Conflict & Difficult Decisions.
Scenarios beginners run into
Healthy adult told to get POLST
Ask whether the clinician meant a living will and proxy instead. POLST is usually for serious illness now, not general wellness planning.
POLST says DNR, family wants full code
EMS and staff follow the valid order in covered emergencies. If the patient has capacity and wants to change the plan, the clinician must issue a new order. If the patient cannot decide, the proxy process applies— not a family vote in the moment.
EMS arrives, no form visible
Default is often full resuscitation attempts unless a valid order is presented. Locate the form, bracelet, or nursing facility sheet while someone meets the crew. For future calls, fix storage and copies.
Living will conflicts with POLST
Call the clinician to reconcile. Hold a goals-of-care meeting. Sign updated documents and remove old versions from the home display.
Nursing home code status
Facilities keep their own code sheets. Confirm the facility chart matches the state POLST on file and that night staff know where it is.
Travel to another state
Some states honor out-of-state POLST; others may not. Before extended travel, ask the clinician and review the destination state's program website. Carry copies and the proxy document.
Situation: A man with end-stage heart failure has a signed POLST declining CPR and ICU-level interventions. He falls at home and his wife calls 911.
What she does: She meets paramedics with the POLST from the refrigerator and states his name and DNR status. She rides with him to the hospital where she gives another copy to registration. She asks the attending to align code status with the POLST and requests palliative symptom care. She emails her children the recap so everyone understands EMS acted according to his documented wishes, not neglect.
Related guides
Goals of Care Conversations, Living Wills, Advance Care Planning, Healthcare Power of Attorney / Proxy, State Advance Directive Forms, Palliative Care, Hospice Care, Caregiving During Hospitalization, and Refusing Treatment.
Official resources
National POLST — Program overview & state links. CaringInfo — Advance directives & DNR information. NIH National Institute on Aging — Healthcare directives. Example state EMS resource — California PREPARE / POLST (check your state).
Search "[your state] POLST" or "[your state] EMS DNR form" for the official form and bracelet rules where you live.