Pennsylvania POLST Form and DNR Orders: What You Need to Know

An advance directive tells your family what you want. A POLST form tells the paramedics standing over you. These are different documents with different legal weight, and confusing them is one of the most dangerous mistakes in Pennsylvania end-of-life planning.

POLST vs. Advance Directive: The Key Difference

A Pennsylvania POLST (Physician Orders for Life-Sustaining Treatment) is a physician-signed medical order. It travels with the patient, sits in the medical chart, and directs emergency responders and clinical staff on exactly what treatments to administer or withhold.

An advance directive is a legal document you create yourself. It designates a healthcare agent and records your treatment preferences, but it requires interpretation by your agent and medical team — it's not a clinical order.

The POLST is designed for people with serious, advanced illnesses or frailty. It converts your wishes into immediate, actionable medical orders that EMS crews can follow without consulting your family or healthcare agent first.

Who Qualifies for a Pennsylvania POLST

The POLST is not for healthy adults. The Pennsylvania Department of Health restricts POLST to individuals who meet one or more of these criteria:

• Advanced chronic progressive illness
• Advanced age and frailty
• A medical condition expected to result in death within a year
• Desire to further define or limit treatment options

Your physician, physician assistant, or certified registered nurse practitioner must sign the POLST after a conversation with you (or your healthcare agent, if you lack capacity). This is not a form you can download and complete on your own.

Out-of-Hospital DNR Orders

Pennsylvania's Out-of-Hospital DNR is a separate order issued by the Department of Health's Bureau of EMS. It's specifically designed for use outside hospital settings — at home, in nursing facilities, or during transport.

When EMS arrives and finds an out-of-hospital DNR bracelet, necklace, or the original signed form, they are legally authorized to withhold cardiopulmonary resuscitation. Without this order, Pennsylvania EMS crews are required by protocol to initiate CPR regardless of what your advance directive says.

This is a critical gap: your living will might clearly state "no resuscitation," but if paramedics arrive at your home, they cannot read and interpret your advance directive in the field. They need the standardized DNR order.

How POLST and DNR Coordinate With Your Advance Directive

Think of these documents as a layered system:

1. Advance Directive — your foundational document. Establishes your healthcare agent and records your values and preferences. Created while healthy or at any point while competent.

2. POLST Form — converts your preferences into clinical orders when you develop a serious illness. Signed by your physician. Addresses CPR, mechanical ventilation, antibiotics, and artificial nutrition.

3. Out-of-Hospital DNR — specifically addresses the resuscitation question for EMS encounters outside a hospital.

Your POLST should align with your advance directive, but if they conflict, the more recently dated document generally takes precedence. This is why updating all three when your condition or preferences change matters.

What the POLST Covers

The standard Pennsylvania POLST form addresses four treatment categories:

Section A — Cardiopulmonary Resuscitation: Full CPR or do not attempt resuscitation (DNAR)

Section B — Medical Interventions: Full treatment, selective treatment (IV fluids, cardiac monitoring, but no intubation), or comfort measures only

Section C — Antibiotics: Full treatment, limited use, or none

Section D — Artificially Administered Nutrition: Long-term feeding tubes, time-limited trial, or no artificial nutrition

Common Mistakes

Treating a POLST like an advance directive. A POLST is not a substitute for an advance directive. It doesn't designate a healthcare agent or address who makes decisions when you can't. You need both.

Not having a DNR order for home. If you want to avoid resuscitation at home, a living will alone is insufficient. You need the out-of-hospital DNR order signed by your physician and kept visible to EMS.

Not updating when you transfer between facilities. A POLST completed at one hospital may not automatically transfer to a new facility or home health agency. Verify that every provider in your care chain has the current version.

The Pennsylvania Advance Directive & Living Will Kit includes a POLST/DNR coordination worksheet that maps exactly how these documents interact under Pennsylvania law and tracks which ones you've completed.

See more Pennsylvania guides →