How to Get and Fill Out the Illinois DNR Form (POLST)

The Illinois DNR form — officially the IDPH Uniform Practitioner Orders for Life-Sustaining Treatment, or POLST — is a one-page medical order that tells paramedics and hospital staff whether to attempt CPR and how aggressively to treat other emergencies. You get it from your doctor, nurse practitioner, or physician assistant, or you download it from the Illinois Department of Public Health website. It only becomes a binding order after you discuss your options with a qualified practitioner, you both sign it, and you store it where first responders can find it.

A POLST is different from a living will. A living will states your general wishes, but EMTs cannot act on it; they have to keep resuscitating you until a physician reviews it. A POLST is a physician’s order, which means paramedics can honor it the moment they arrive.

Who Can Sign an Illinois POLST

Any adult of sound mind can execute one. Under 755 ILCS 40/65, an individual who has reached the age of majority or been emancipated may direct that resuscitation efforts not be implemented, and may revoke that directive at any time.¹ The form is designed for people with a serious or life-limiting illness who face a realistic risk of a life-threatening emergency, not healthy people planning decades in advance.²

Signing is always voluntary. No hospital, nursing home, or other facility can require a POLST as a condition of admission or care.¹

If you lack the capacity to make your own medical decisions, someone else can consent to a POLST on your behalf: your legal guardian, an agent you named in a healthcare power of attorney, or a surrogate decision-maker identified under the Health Care Surrogate Act.¹ A surrogate is expected to follow your known wishes when possible and otherwise act in your best interest.³

Where to Get the Form

Ask your doctor, nurse practitioner, or physician assistant for the current IDPH Uniform POLST. Hospitals, skilled nursing facilities, and long-term care facilities also stock it and often raise it at admission. You can download it directly from the IDPH advance directives page at dph.illinois.gov.² There is no fee.

A Spanish-language version is available. Under 20 ILCS 2310/2310-600, IDPH is required to publish Spanish-language versions of all major advance directive forms, the POLST included.⁴

How to Fill Out the Form

The form is built around three treatment decisions, each in its own section. You work through them with your practitioner in a face-to-face conversation about your diagnosis, prognosis, and goals. The top of the form also collects your name, date of birth, and address so it can be matched to your medical record.⁵

Section A: CPR

This section applies only when you have no pulse. There are two choices:

Yes CPR. Attempt cardiopulmonary resuscitation using all indicated methods. If you pick this, you must also pick Full Treatment in the next section.
No CPR (DNAR). Do not attempt resuscitation. If your heart stops, personnel will not perform chest compressions, intubation, or defibrillation.²

Section B: Medical Interventions

This governs your care while you still have a pulse. Maximizing comfort is a goal under every option.⁵

Full Treatment. Use all available interventions to prevent cardiac arrest, including intubation, mechanical ventilation, cardioversion, and hospital transfer.
Selective Treatment. Treat medical conditions but with limits. No intubation or invasive mechanical ventilation. Non-invasive positive airway pressure (CPAP, BiPAP), IV fluids, antibiotics, and cardiac medications are permitted. Hospital transfer is allowed when appropriate.
Comfort-Focused Treatment. Manage symptoms and allow a natural death. Medication by any route, oxygen, suctioning, and manual airway clearance are all permitted. Transfer to a hospital happens only if comfort cannot be achieved where you are.

Selective Treatment is the choice most people need to think hardest about. It still authorizes significant medical care, including IV antibiotics and cardiac drugs, but draws a hard line at putting a tube down your throat. If that distinction matters to you, raise it explicitly with your practitioner.

Section C: Medically Administered Nutrition

This covers artificial feeding and hydration.⁵

Provide artificial nutrition and hydration by any means, including new or existing surgically placed tubes.
Trial period for artificial nutrition and hydration, but no surgically placed tubes. This lets you test whether artificial nutrition improves your condition without committing to a permanent feeding tube.
No artificial nutrition or hydration.

Whichever box you check, staff are directed to offer food by mouth if you can tolerate it. If you leave the section blank, providers follow the standard of care.

Signatures That Make It Legal

A POLST is not self-executing. It needs the signature of a qualified healthcare practitioner — a licensed physician, advanced practice registered nurse, or physician assistant — to become a binding medical order. If more than one practitioner shares responsibility for your care, any of them may sign.¹ That signature confirms your options were discussed and the orders reflect your informed consent.

You (or your authorized legal representative) must also print and sign your name in the consent section. A witness signature is no longer required under Illinois law and has been removed from the current form.² If an older version you were given still shows a witness line, a witness signature does no harm, but it is not required.

Illinois also allows electronic POLST forms. They may be created, signed, or revoked electronically through any technology-neutral system where each user has a unique identifier, as long as it meets the Uniform Electronic Transactions Act or the Hospital Licensing Act’s medical record authentication rules.⁴

What to Do With the Form Once It’s Signed

A signed POLST does nothing if responders cannot find it. Physical handling matters.

Keep the original in a visible location in your home. The refrigerator door is the standard spot, and paramedics are trained to check there. Photocopies, faxes, and digital copies on any color paper are legally valid in Illinois, so give copies to your primary care physician, your local hospital (ask that it be entered into your electronic medical record), and anyone likely to be present during an emergency.⁶ If you live in a nursing home or assisted living facility, the staff keeps your POLST in your chart and makes it available to responding personnel.

When EMS arrives, they look for the form before deciding whether to begin life-saving measures. If it is not apparent and immediately available, responders default to full resuscitation. Under 755 ILCS 40/65, a provider who complies in good faith with a valid POLST is protected from criminal and civil liability except in cases of willful and wanton misconduct.⁷

How to Change or Revoke the Form

If you have decisional capacity, you can revoke the form at any time and request different treatment. You do not need anyone’s permission. To void the document, draw a line through sections A through E, write “VOID” across the page, add the date, and re-sign. If your POLST is in an electronic medical record, follow the facility’s procedure for voiding electronic orders.⁸

You cannot just cross out one line and initial it. Changing any part of the form requires completing an entirely new one with your practitioner, then voiding the old one. Tell everyone who holds a copy — your doctor’s office, the hospital, family members — so an outdated version does not surface during an emergency.

POLST forms do not expire. Once signed, yours remains in effect until you revoke it or replace it. IDPH recommends reviewing the form periodically, especially after a new diagnosis, a significant change in health, or a move to a different care facility.²

Where the POLST Does Not Reach

A POLST does not appoint anyone to make future decisions for you; that is what a healthcare power of attorney does. It also does not cover treatment preferences for conditions you have not yet developed; that is where a living will remains useful. The strongest plan uses all three documents together.

End-of-life orders are governed by state law, not federal law, and each state has its own form and requirements. There is no federal mandate requiring one state to honor another state’s POLST.⁹ If you split time between states, complete the other state’s version as well. Providers may try to honor the spirit of an out-of-state form, but relying on that in a fast-moving emergency is a gamble.

1
FindLaw. Illinois Code 755-40/65 – Department of Public Health Uniform POLST Form
2
Illinois Department of Public Health. POLST Guidance for Individuals
3
Illinois Guardian and Advocacy Commission. Health Care Surrogate Act
4
Illinois General Assembly. 20 ILCS 2310/2310-600 – Advance Directive Information
5
Illinois Department of Public Health. IDPH Uniform Practitioner Order for Life-Sustaining Treatment (POLST) Form
6
Illinois Department of Public Health. POLST Guidance for Health Care Providers and Professionals
7
Illinois General Assembly. Public Act 098-1110
8
Memorial Health. IDPH Uniform Practitioner Order for Life-Sustaining Treatment (POLST) Form
9
National POLST. National POLST Form