DNR Order at Home in Tennessee: What First Responders Need to See

If paramedics arrive at your Tennessee home and find you in cardiac arrest, they are legally required to begin full CPR and life-support measures — unless they can physically see a valid out-of-hospital DNR order or a Physician Orders for Scope of Treatment (POST) form. Your advance directive, no matter how clearly it states your wishes, does not have legal authority over emergency responders.

This disconnect catches families off guard. A patient with a detailed advance directive saying "do not resuscitate" may still receive aggressive interventions if the EMTs don't have the right form in front of them.

The Out-of-Hospital DNR Order

A Universal Do Not Resuscitate (DNR) order, authorized under T.C.A. §§ 68-11-224 and 68-11-47, directs healthcare staff not to attempt CPR if your heart stops or you stop breathing. For it to be valid:

• A licensed physician with a bona fide physician-patient relationship must sign it
• The patient (or their authorized surrogate) must consent
• The order must be documented in writing

The critical feature: this order is honored by EMS personnel in the field, not just by hospital doctors. EMTs in Tennessee are trained to look for this form during emergency calls.

DNR vs. POST Form: When You Need Which

The DNR order covers one specific scenario: cardiac or respiratory arrest. It's binary — attempt resuscitation or don't.

The POST form (Form PH-4193, governed by T.C.A. § 68-11-224) is broader. It covers four categories of medical decisions: CPR, level of medical intervention, antibiotic use, and artificial nutrition. The POST includes a DNR option in Section A, but it also addresses what happens short of cardiac arrest — whether you want ICU-level treatment, limited interventions, or comfort measures only.

For most seriously ill patients, the POST form is the better option because it addresses a wider range of medical decisions. The standalone DNR order is useful when a patient specifically wants to refuse CPR but otherwise wants full medical treatment.

How to Get a DNR or POST Form

Both forms require a physician's involvement — you cannot create them yourself.

For a DNR order:

1. Discuss your wishes with your treating physician
2. Your physician completes and signs the DNR order
3. You (or your surrogate) also sign, indicating consent
4. Keep the original form where EMTs can find it

For a POST form:

1. Request Form PH-4193 from your physician, hospital, or the Health Facilities Commission
2. Discuss each section — CPR, interventions, antibiotics, nutrition
3. Your physician completes the form based on your stated preferences
4. Both you and the physician sign
5. Faxes and photocopies are legally valid in Tennessee

Where to Display the Form at Home

Emergency responders need to find your DNR or POST form within seconds of arriving at your home. Standard placement:

• Refrigerator door — EMTs are trained to check the refrigerator in many jurisdictions
• Near the front entrance — taped to the inside of the front door or on a nearby wall
• Bedside — if the patient is bedridden, keep the form attached to the bed frame or headboard
• In a designated medical file — a brightly colored folder labeled "Medical Orders" or "DNR" kept in a consistent, accessible location

Do not store the form in a locked safe deposit box, a filing cabinet, or anywhere that requires a key or combination. If EMTs can't find it, they must begin resuscitation.

If you travel between your home and a care facility, the POST form travels with you. Make sure a copy stays at each location where you spend time.

The Advance Directive's Role

Your advance directive is not useless in this picture — it serves a different function. While EMTs follow the DNR or POST form during an emergency, your advance directive guides the hospital physicians once you're admitted. It tells them your broader treatment preferences and authorizes your healthcare agent to make decisions on your behalf.

The strongest protection uses all three documents together: an advance directive for ongoing medical decisions, a POST form for emergency treatment orders, and your healthcare agent's real-time involvement for anything the forms don't cover.

The Tennessee Advance Directive & Living Will Kit includes a POST/DNR comparison guide and explains exactly how to coordinate all three documents so your wishes are honored in every medical setting.

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