# POLST vs DNR: what each means for an elderly parent

> POLST vs DNR for an aging parent: what each form covers, who signs it, how it relates to an advance directive, and where to keep it so EMS sees it.

Canonical: https://getparentfile.com/guides/polst-vs-dnr-for-parent  
Updated: 2026-10-30 · Publisher: ParentFile  
Organizational guidance for families. Not medical or legal advice.

## Short answer

A DNR (do-not-resuscitate) order covers one decision: whether to attempt CPR if your parent's heart or breathing stops. A POLST is a broader medical order for people who are seriously ill or frail: it records a CPR choice too, but also the level of treatment your parent wants (full, selective or comfort-focused) and, on the national form, a choice about tube feeding. Both are signed with a clinician. In one line: every POLST answers the DNR question, but a DNR doesn't answer the POLST questions. Whichever your parent has, keep the signed form where emergency responders will look and tell the family where it is.

A doctor may have mentioned a "DNR" or a "POLST" for your parent. Both deal with emergencies, but they are not the same form. Here is the difference, who signs each one, how they fit with an advance directive, and the part families often miss: making sure the form is found when it matters.

> This guide explains forms and terms so you can have a better conversation with your parent and their clinician. It is not medical or legal advice. The rules differ by state.

## POLST vs DNR at a glance

| | DNR order | POLST form |
|---|---|---|
| What it covers | CPR only (chest compressions, breathing tube, shocks, related drugs) | CPR choice, plus level of treatment and other orders such as tube feeding |
| Who it's for | Anyone who decides with their clinician not to have CPR | People who are seriously ill or frail |
| Who signs | A clinician, after talking with the patient or their decision-maker | A clinician and the patient (or their legal surrogate) |
| Where it applies | Hospital DNRs live in the chart; "out-of-hospital" DNRs are separate state forms | Designed to travel with the person: home, nursing home, ambulance, hospital |
| Names you may see | DNR, DNAR, out-of-hospital DNR, prehospital DNR | POLST, MOLST, POST, MOST, LST and others, depending on the state |

## What a DNR order is

A DNR is a medical order written by a health care provider, ideally before an emergency and after a conversation with the patient, or with their health care proxy or family if the patient can't take part ([MedlinePlus, 2026](https://medlineplus.gov/ency/patientinstructions/000473.htm)). It is specific to CPR. It does not stop other care such as pain medicine or other medicines.

Two details matter for families:

- **A hospital DNR usually stays in the hospital.** It is written in the medical record. When your parent goes home, many states need a separate **out-of-hospital (or prehospital) DNR** form so 911 responders can honor it.
- **Responders need proof on the spot.** California's EMS Authority says that without clear evidence of a valid DNR, paramedics will start resuscitation, even if the family asks them not to. Many states also approve a DNR **bracelet or medallion**, which can be more reliable than paper because it stays on the person. Texas, for example, says an approved DNR device is honored in place of the form ([Texas DSHS](https://www.dshs.texas.gov/sites/default/files/emstraumasystems/FAQsforDNR.pdf)).

## What a POLST form is

National POLST describes POLST as a **portable medical order** that tells health care personnel which treatments a person does and does not want if they can't speak for themselves. It starts with a conversation with the health care team, and it is **always voluntary** ([National POLST](https://polst.org/for-patients/)).

The current National POLST Form (revised May 2025) has these main sections:

1. **CPR:** Yes CPR, or No CPR (do not attempt resuscitation).
2. **Initial treatment orders:** *full treatments* (including intensive care), *selective treatments* (treat the problem, avoid intensive care where possible), or *comfort-focused treatments*.
3. **Additional orders**, for example about dialysis or blood products.
4. **Medically assisted nutrition:** feeding tube, a time-limited trial, no tube, or not yet decided.
5. **Signatures** of the patient or their surrogate, and of the health care provider.

Your parent's state may use its own version and a different name. New York uses the **MOLST** (form DOH-5003), and the New York State Department of Health says it is the only authorized form there for a nonhospital DNR and do-not-intubate order. Other states call it POST, MOST or LST. National POLST keeps a [directory of state programs](https://polst.org/state-programs/), so start there to find your parent's form.

## POLST vs advance directive: how they fit together

The MSD Manual's comparison boils down to this ([MSD Manual](https://www.msdmanuals.com/home/multimedia/table/differences-between-advance-directives-and-polst)):

- **Advance directive:** any adult can complete one, healthy or not. It records wishes about future care and usually names a health care agent. It is usually **not** something EMS can act on in an emergency.
- **POLST:** completed only with a clinician, for someone who is seriously ill or frail. It turns those wishes into **current medical orders** that apply in an emergency.

They work best together. The advance directive names who speaks for your parent; the POLST tells the ambulance crew what to do right now. If your parent has neither, the healthcare power of attorney and advance directive usually come first. Our guide to [important documents for aging parents](https://getparentfile.com/guides/documents-for-aging-parents) covers that core set, and a [HIPAA release form](https://getparentfile.com/guides/hipaa-release-form-for-parent) lets doctors share information with you.

## Who signs, and can you sign for your parent?

A clinician must sign either form. Depending on the state, that can be a physician, nurse practitioner or physician assistant. Your parent signs too, as long as they can make the decision.

If your parent can no longer decide, a **legally recognized surrogate** may sign, such as the health care agent named in a healthcare power of attorney, a guardian, or in some states a close relative. The National POLST Form leaves surrogate authority to state law. As an adult child you may be that person, but only if your state's rules say so. This is a good question to bring to your parent's doctor or an elder-law attorney.

## Where to keep it so it's actually found

A form nobody can find during a 911 call doesn't help. Practical steps:

- **At home:** National POLST suggests the **refrigerator** or the **medicine cabinet**, places responders know to check ([National POLST FAQ](https://polst.org/for-patients/faqs/)). If your parent uses a [Vial of Life or File of Life](https://getparentfile.com/guides/vial-of-life-file-of-life) packet, ask your local EMS whether to keep the form with it.
- **In a facility:** make sure the nursing home or assisted living staff has it on file and that it goes with your parent on any transfer.
- **When traveling:** keep a copy with your parent's ID.
- **Copies:** the National POLST Form says copied, faxed or electronic versions are valid orders. State DNR rules vary. Texas accepts photocopies but says a photo on a phone isn't a copy.
- **Wallet card and bracelet:** if your parent has a state-approved DNR bracelet or medallion, note it. A [medical ID wallet card](https://getparentfile.com/guides/medical-id-wallet-card) can say where the signed form is kept.
- **Tell people:** every sibling and caregiver should know it exists and where it is. Bring a copy when you [go to the ER](https://getparentfile.com/guides/what-to-bring-to-the-er).

## When to review it

The National POLST Form does not expire, but it says to review it when your parent moves between care settings, has a big change in health, changes primary clinician, or changes their mind. Your parent (or their surrogate) can change or cancel a POLST at any time. To void a paper form, it is destroyed, the change is noted in the record, and the clinician (and any state registry) is told.

## Printable checklist: POLST or DNR for a parent

- [ ] Ask your parent's clinician whether a POLST (or your state's version) fits your parent's health right now
- [ ] Find your state's form name and program in the National POLST directory
- [ ] Your parent's own goals discussed with the clinician (and with the health care agent, if named)
- [ ] Form signed by the clinician and by your parent or their legal surrogate
- [ ] Original posted on the fridge or medicine cabinet (or where local EMS advises)
- [ ] Copy given to the nursing home, assisted living or home care agency, if any
- [ ] State-approved DNR bracelet or medallion ordered, if your parent wants one
- [ ] Every sibling and caregiver told that it exists and where it is
- [ ] Location written on the ER sheet and wallet card
- [ ] Review set for after any hospital stay, move, or change in health

## Where ParentFile fits

ParentFile doesn't create, sign or check any medical order, and it doesn't tell you which choice to make. It is an organization tool. In its documents map you record whether your parent has a POLST or DNR and where the signed original is kept, and the one-page ER sheet shows that location, so whoever is with your parent can point responders to it.

## Frequently asked questions

### What is the difference between a POLST and a DNR?

A DNR is a medical order about one thing: whether to attempt CPR if the heart or breathing stops. A POLST is a broader medical order for people who are seriously ill or frail. It also records a CPR choice, but adds orders about the level of treatment (full, selective or comfort-focused) and, on the national form, about tube feeding.

### Is a POLST the same as an advance directive?

No. An advance directive is a document any adult can complete to record wishes and usually to name a health care agent. A POLST is a medical order signed by a clinician, meant for people who are seriously ill or frail, and it is written so emergency responders can act on it. Many people have both.

### Who signs a POLST or DNR form for an elderly parent?

A health care professional must sign it: a physician, or in many states a nurse practitioner or physician assistant. Your parent signs too, or, if they can no longer decide, a legally recognized surrogate such as their health care agent. The rules on who can sign come from state law.

### Where should my parent keep a POLST or DNR form at home?

Somewhere emergency responders will look. National POLST suggests the refrigerator or the medicine cabinet at home, and keeping a copy with ID when traveling. Tell family members and caregivers exactly where it is.

### Is a copy of a POLST form valid?

The National POLST Form says a copied, faxed or electronic version is a valid medical order, and National POLST says copies are accepted in almost all states. State DNR forms can differ. Texas, for example, accepts photocopies but not a photo of the form on a phone, so check your parent's state program.

## Sources

- [National POLST Form (Revision May 2025)](https://polst.org/wp-content/uploads/2026/06/National_POLST-Form-2025Rev.pdf), National POLST
- [Frequently Asked Questions About POLST (for patients)](https://polst.org/for-patients/faqs/), National POLST
- [POLST: for patients](https://polst.org/for-patients/), National POLST
- [POLST state programs](https://polst.org/state-programs/), National POLST
- [Do-not-resuscitate order](https://medlineplus.gov/ency/patientinstructions/000473.htm), MedlinePlus, U.S. National Library of Medicine
- [Differences Between Advance Directives and POLST (table)](https://www.msdmanuals.com/home/multimedia/table/differences-between-advance-directives-and-polst), MSD Manual, Consumer Version
- [Out-of-Hospital DNR: frequently asked questions](https://www.dshs.texas.gov/sites/default/files/emstraumasystems/FAQsforDNR.pdf), Texas Department of State Health Services