New Hampshire DNR and POLST Forms: What They Are and How to Get One

If someone you love has a serious illness and you want to make sure paramedics respect their wishes, you need to understand a critical distinction that most families miss: an advance directive is not a DNR, and a DNR is not a POLST. In New Hampshire, each document serves a different purpose, is signed by different people, and operates in different settings.

Getting them confused can mean unwanted CPR during a crisis — even when the patient's preferences are clearly documented elsewhere.

The Advance Directive vs. Medical Orders

Your New Hampshire advance directive under RSA 137-J is a legal planning document. It records your future wishes and designates a healthcare agent. But it does not give direct instructions to emergency responders. If you call 911, paramedics are legally required to perform CPR unless they see a specific, signed medical order telling them not to.

That medical order is either a DNR (Do Not Resuscitate) or a POLST (Provider Orders for Life-Sustaining Treatment). Both must be signed by a licensed clinician — a physician, physician assistant, or advanced practice registered nurse. You cannot create them yourself.

The Portable DNR (P-DNR)

A DNR order specifically directs medical staff not to perform cardiopulmonary resuscitation if the patient's heart or breathing stops. In a hospital setting, this is straightforward — the order is part of the medical chart.

At home, the challenge is that EMS crews arriving at a scene don't have access to hospital charts. New Hampshire addresses this with the Portable DNR — a document printed on distinctive bright pink paper that the patient or family keeps posted in a visible location at home, typically on the refrigerator or near the front door.

When paramedics see the pink Portable DNR form, they have legal authority to withhold CPR. Without it, they must resuscitate — regardless of what the patient's advance directive says.

To obtain a Portable DNR:

1. Discuss the decision with the patient's attending physician
2. The physician signs the P-DNR order
3. The form is printed on the required pink paper
4. Post the original in a visible location at home
5. Carry a copy with the patient during any travel or transport

The POLST Form

The POLST is a broader document than a DNR. Printed on bright yellow paper, it translates a patient's values into immediate, actionable medical orders across multiple treatment categories — not just resuscitation. A POLST covers:

• CPR preferences (attempt resuscitation vs. do not attempt)
• Medical interventions (full treatment, selective treatment, or comfort-focused treatment)
• Artificial nutrition (long-term feeding tube, trial period, or no artificial nutrition)

The POLST is designed for patients facing serious, life-limiting illness or advanced frailty. It is not intended for healthy adults doing routine advance care planning. A comprehensive clinical conversation must happen before the form is completed, and the clinician must sign it for the orders to be enforceable.

Under the 2021 SB 74 amendments, your designated healthcare agent now has default authority to request and authorize a POLST on your behalf if you lack capacity. This is a significant expansion — previously, agents needed explicit written authorization in the advance directive to take this step.

How the Documents Work Together

Think of these three documents as a layered system:

Your advance directive informs the clinical conversation. Your physician uses your documented preferences — and your agent's input if you lack capacity — to determine whether a DNR or POLST is appropriate. The medical orders then give direct, enforceable instructions to every provider who encounters them.

Common Mistakes

Assuming the advance directive is enough for home emergencies. It's not. EMS crews follow medical orders, not legal planning documents. If the patient wants to avoid CPR at home, they need a signed Portable DNR on pink paper, posted visibly.

Completing a POLST too early. The POLST is designed for patients with serious illness. A healthy 55-year-old doing proactive planning needs an advance directive, not a POLST. The POLST conversation happens later, when a clinical condition makes it appropriate.

Not updating after a hospitalization. POLST orders created during a hospital stay should be reviewed and reissued for the home setting. The hospital's internal DNR order does not travel with the patient after discharge.

The New Hampshire Advance Directive & Living Will Kit explains how each document fits into your planning and guides your healthcare agent through the process of converting your advance directive preferences into active medical orders when the time comes.

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