Indiana POST Form and Out-of-Hospital DNR: What You Need to Know

When a family member has a terminal diagnosis or advanced frailty, an advance directive alone may not be enough. The advance directive expresses general preferences, but it is not binding on emergency responders arriving at your home. That is where Indiana's POST form and out-of-hospital DNR order fill the gap.

These are medical orders, not planning documents. They tell paramedics and first responders exactly what to do — or not do — when they arrive.

POST Form: Physician Orders for Scope of Treatment

Indiana's POST program is the state's version of the national POLST (Physician Orders for Life-Sustaining Treatment). It translates patient preferences into actionable, detailed medical orders signed by a treating physician, advanced practice registered nurse (APRN), or physician assistant (PA).

A POST form is appropriate for individuals with advanced chronic progressive illness, severe frailty, or a terminal condition where death within 12 to 24 months would not surprise the treating clinician. It is not designed for healthy adults doing routine advance care planning.

The POST form covers:

• Resuscitation status — attempt CPR or do not resuscitate
• Medical interventions — comfort measures only, limited interventions, or full treatment
• Artificial nutrition — long-term feeding tubes, trial period, or no artificial nutrition
• Antibiotics — full course, limited use, or comfort-focused only

Unlike an advance directive, the POST form is a direct, legally enforceable medical order that travels with the patient across all clinical settings — emergency transport, hospice, hospitals, and long-term care facilities.

The Indiana State Department of Health recommends printing the POST on Astrobright's Pulsar Pink 65lb paper so first responders can immediately identify it. Photocopies and electronic versions are legally valid, but the bright pink paper ensures recognition during an emergency.

Out-of-Hospital DNR Order

The out-of-hospital DNR, governed by Indiana Code § 16-36-5, is a specific medical order instructing EMS and first responders to withhold CPR if the patient's heart or breathing stops outside a hospital. It uses State Form 49559.

The key distinction: a DNR is narrower than a POST. It addresses only the resuscitation question — should paramedics attempt CPR or not. A POST form covers resuscitation plus the broader scope of treatment decisions.

For patients who always carry the DNR document, the Indiana State EMS Commission has designated MedicAlert as the only approved and legally recognized out-of-hospital identification device. A MedicAlert bracelet or necklace with the DNR designation is legally equivalent to carrying the paper form.

DNR vs. POST vs. Advance Directive

These three documents serve different purposes at different stages:

Advance directive — your general preferences about treatment, plus your Health Care Representative appointment. Primarily effective in hospital settings. Not binding on emergency responders.

Out-of-hospital DNR — a medical order addressing only resuscitation. Binding on EMS. Requires a physician signature.

POST form — a comprehensive medical order covering resuscitation, interventions, nutrition, and antibiotics. Binding across all settings. Requires a physician signature. Most appropriate for patients with serious illness or frailty.

Most people with a terminal diagnosis benefit from having all three: the advance directive for hospital-based decisions and HCR authority, the POST for portable medical orders across settings, and the DNR specifically for the resuscitation question outside hospitals.

How to Get a POST or DNR in Indiana

Both forms require a conversation with your physician. You cannot self-execute a POST or DNR the way you can an advance directive — these are medical orders that must be signed by a licensed clinician.

The process typically begins during a serious illness diagnosis, hospice intake, or nursing facility admission. Your physician reviews your treatment preferences, translates them into medical orders, and signs the form.

If the patient lacks capacity, the Health Care Representative can work with the physician to complete the POST based on the patient's known preferences or best interests.

The Indiana Advance Directive & Living Will Kit explains how the POST and DNR coordinate with your advance directive, including a post-DNR coordination checklist that covers notification of all relevant healthcare providers.

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