Document name
The DNR form has been replaced by POLST (Physician’s Order for Life Sustaining Treatment) form.
Where do you get the form
You should request the form from your physician but you can see a blank form at:
http://www.wsma.org/Media/Patients-pdfs/POLST-PrintDownload.pdf
Please note that the form must be printed on terra green (a bright green color) cardstock.
Who is permitted to request the form
Any adult with an advanced life limiting illness can request the form.
Who signs the form
The physician, nurse practitioner or certified physician assistant and the patient sign the form.
How do you obtain a DNR bracelet
n/a
Revoking a DNR
n/a
Photocopy
A copy is legal.
State info link
Other link
Special notes
Order a Vial of Life decal for your front door. The decal informs an Emergency Medical Services team that a POLST has been prepared and can found in refrigerator.