Out-Of-Hospital Do-Not-Resuscitate (DNR) Orders
A Guide for Patients and Families

Out-of-Hospital Nonresuscitation Act. On November 29, 2006, Pennsylvania enacted a statute (P.L. 1484, No. 169) that repealed the DNR Act and replaced it with the Out-of-Hospital Nonresuscitation Act (Act) (20 Pa.C.S. §§ 5481-5488). The effective date of the Act is January 28, 2007. The Act empowers a person with an end-stage medical condition or an appropriate representative of that person to secure an out-of-hospital DNR order and, at the person’s option or the option of an authorized representative, an out-of-hospital DNR bracelet or necklace. These items, just as those that were issued under the former DNR Act, direct EMS personnel in the out-of-hospital setting not to provide the person for whom they were issued with CPR in the event of the person’s cardiac or respiratory arrest. The Act also specifies the circumstances under which an appropriate representative of a person who issued a living will under the Living Will Act (20 Pa.C.S. §§ 5441-5447) is able to secure an out-of-hospital DNR order, bracelet or necklace for the person. (The Living Will Act replaced the Advance Declaration for Health Care Act. Hereafter, the repealed Advance Declaration for Health Care Act will be referred to as “the former Living Will Act” and a declaration issued under that statute will be referred to as a “living will,” the same as a living will under the Living Will Act.)

Click on the links below to download more information about DNR orders

DNR Supply Order Form (Health Care Providers Only)

Sample Out-Of-Hospital DNR Order (Prior versions of this form remain valid and are to be honored)

Picture of DNR Bracelet & Necklace

Note: The files listed above are in PDF format and require the free Adobe Acrobat Reader to be installed on your computer in order to access, view the file, and print copies. Please click here to learn more about Adobe Acrobat Reader.

Pennsylvania - Orders for Life-Sustaining Treatment (POLST)

POLST is a medical order that gives patients more control over their end-of-life care. The POLST form specifies the types of medical treatment that a patient wishes to receive towards the end of life. These medical orders are signed by both a patient’s physician, physician’s assistant, or certified registered nurse practitioner and the patient or the patient’s surrogate

Completion of a POLST form is only a small step in the process of a patient’s decision-making, and it is critical that this form be used as part of a program for end of life decisions that includes educational support and other aspects of planning for providers and patients.

This form was developed by the Pa Department of Health's Patient Life Sustaining Wishes Committee and was designed to be consistent with Pennsylvania law. There are significant advantages to using a form that contains standardized language and is produced in a distinctive and easily recognizable format. In order to maintain continuity throughout Pennsylvania, please follow these printing instructions:

*** Print POLST Form on Pulsar Pink Card Stock (65#)***

Click on the links below to download

See additional instructions on the POLST form related to completing and using the form.