State portable medical orders, EMS DNR forms, electronic death certification systems and medical aid-in-dying reports, with who signs and where each goes.
End-of-life paperwork falls into four groups: portable medical orders (POLST and its state names, MOLST, MOST and POST), out-of-hospital DNR orders, the medical certification on the death certificate, and medical aid-in-dying reports. New York's MOLST (DOH-5003), Colorado's MOST and the Illinois IDPH Uniform POLST are typical order forms. Death certification now runs through state electronic systems, such as DAVE in New York and Maine and DRIVE in Indiana. This page lists 89 forms and systems.
Most POLST-type forms need a physician, NP or PA signature, but rules differ. Connecticut requires DPH MOLST training, and New York allows only a physician to sign for patients with intellectual or developmental disabilities. Some orders must be on colored paper, like Florida's yellow DNRO (DH Form 1896) and North Carolina's pink MOST, and several states accept only official forms ordered from the program. Aid-in-dying reports run on deadlines: Oregon wants the attending physician's compliance form within 7 calendar days of the prescription.
National model death certificate whose medical certification section (cause of death, manner, injury details) every state certificate and EDRS follows.
NCHS guidance with instructions and worked examples for completing the medical certification (cause-of-death) section of the death certificate.
Model portable medical order for CPR, initial treatment and artificial nutrition that states may adopt as their official POLST form.
Portable medical order for seriously ill Alabamians recording CPR and treatment-intensity decisions; ADPH links the National POLST form.
Portable medical order for seriously ill or frail patients recording CPR and treatment-intensity orders; Arizona uses the National POLST Form.
Statutory orange DNR form (A.R.S. 36-3251) that EMS providers honor to withhold resuscitation from a qualified individual.
Portable physician order documenting resuscitation, medical interventions and artificial nutrition preferences for seriously ill patients under the Arkansas POLST Act (2017).
Portable medical order for CPR, medical interventions and artificially administered nutrition for seriously ill or frail Californians (Probate Code 4780 et seq.).
Documents the attending physician's eligibility determinations, required counseling and request dates under California's End of Life Option Act when an aid-in-dying drug is prescribed.
Reports whether the patient ingested the aid-in-dying drug and the circumstances of death.
Consulting physician confirms terminal diagnosis, prognosis, capacity and voluntariness of a patient requesting an aid-in-dying drug.
Portable medical order for CPR, level of medical intervention and artificially administered nutrition for adults with chronic or serious illness.
Required report from the attending/prescribing provider documenting compliance with the Colorado End-of-Life Options Act when medical aid-in-dying medication is prescribed.
Medical order set guiding life-sustaining treatment for patients with serious illness, signed by a MOLST-certified provider and honored across settings.
Portable medical order for CPR, medical interventions and artificial nutrition for District patients with serious illness.
Documents the attending physician's compliance with the DC Death with Dignity Act when prescribing covered medication.
Consulting physician confirms diagnosis, prognosis and capacity of a patient requesting medication under the DC Death with Dignity Act.
Psychiatrist or psychologist reports whether a DC Death with Dignity patient has a disorder impairing judgment.
DH Form 1896Florida's statutory pre-hospital DNRO directing EMS and medical personnel not to resuscitate after respiratory or cardiac arrest (s. 401.45, F.S.; Rule 64J-2.018).
Voluntary portable physician order recording CPR, medical intervention and nutrition preferences for seriously ill Floridians.
Portable medical order recording CPR, treatment intensity and nutrition decisions for seriously ill patients in Hawaii.
Reports the outcome and circumstances of death of a patient who received aid-in-dying medication.
Documents the attending provider's compliance with the Our Care, Our Choice Act when prescribing medical aid-in-dying medication.
Consulting provider confirms diagnosis, prognosis and capacity of a patient requesting medication under the Our Care, Our Choice Act.
Mandatory mental health counseling determination that the patient is capable and not suffering from undertreated depression or another condition impairing judgment.
Medical orders for individuals with serious illness or approaching end of life covering resuscitation and scope of treatment; complements the advance directive.
Formulario de Órdenes del Médico para el Tratamiento de Soporte Vital (POLST) del IDPH
Portable medical order recording CPR/DNR, scope of treatment and artificial nutrition decisions for patients with serious life-limiting illness or frailty; also serves as Illinois' out-of-hospital DNR.
Electronic registration system in which Indiana medical certifiers complete the cause-of-death certification for death records.
State Form 55317Physician's order for scope of treatment (CPR, interventions, nutrition) for patients with advanced chronic or serious illness under IC 16-36-6.
Double-sided medical order sheet communicating resuscitation, scope of treatment and artificial nutrition preferences for frail elderly or seriously ill Iowans (Iowa Code 144D).
Portable POLST-paradigm order for CPR, medical interventions and nutrition used across Kansas and Missouri.
Standardized medical order for scope of treatment (CPR, interventions, nutrition) under KRS 311.6225.
Physician order form based on the person's condition and preferences covering CPR, scope of treatment and artificial nutrition for patients with life-limiting or irreversible conditions.
Electronic vital events system in which Maine medical certifiers enter the medical certification of death before the record can be registered.
Actionable medical order for people facing terminal illness or advanced frailty, based on the National POLST form.
Attending physician certifies compliance with each requirement of the Maine Death with Dignity Act when prescribing medication.
Consulting physician confirms terminal diagnosis, competence, voluntariness and informed decision of a Death with Dignity patient.
Attending physician's follow-up report on the outcome after a Death with Dignity prescription.
Portable, enduring medical order form for CPR and other life-sustaining treatments, valid in all Maryland health care facilities and programs and for EMS.
Medical order form relaying a seriously ill patient's decisions on CPR, ventilation, hospital transfer and other life-sustaining treatment across care settings.
Órdenes Médicas de Michigan para Alcance del Tratamiento (MI-POST)
Optional 1-page, 2-sided medical order recording CPR, critical care and other treatment wishes for people with serious advanced illness or frailty (Public Act 154 of 2017).
Portable provider order for CPR, treatment intensity and artificial nutrition for seriously ill or frail Minnesotans.
Portable medical order honored by EMS and facilities for CPR and scope-of-treatment decisions; also replaces Montana's Comfort One program.
Actionable medical order for patients near the end of a life-limiting illness or very frail, honored in all settings.
Portable medical order (bright yellow) recording resuscitation and treatment decisions; can serve as a DNR order without a separate form.
Statutory out-of-hospital DNR order (bright pink form or wallet card) honored by EMS; required for a DNR bracelet or necklace.
Portable medical order completed jointly by a patient and practitioner documenting CPR, treatment intensity and nutrition preferences.
Documents the attending physician's compliance with the Medical Aid in Dying for the Terminally Ill Act when prescribing aid-in-dying medication.
Reports the outcome and circumstances of death of a patient who obtained medical aid-in-dying medication.
Consulting physician confirms terminal diagnosis, prognosis and capacity of a patient requesting medical aid in dying.
Mental health professional reports whether a patient requesting medical aid in dying has a condition impairing judgment.
Standardized out-of-hospital do-not-resuscitate order that authorizes EMS providers to withhold resuscitation under NMAC 7.27.6.
Prescribing provider reports each aid-in-dying prescription under the Elizabeth Whitefield End-of-Life Options Act (demographics, hospice status, condition, ingestion).
Portable medical order documenting CPR/DNR, intubation (DNI) and other life-sustaining treatment decisions that all providers must follow across care settings; the only authorized NY form for a nonhospital DNI order.
Electronic system (formerly EDRS) used to register and medically certify deaths and fetal deaths occurring in New York State outside New York City.
Electronic system in which NYC medical facilities and certifiers report deaths and certify cause of death for New York City death certificates.
Standard out-of-hospital DNR order that EMS and other providers must honor for a person outside a hospital.
Attending physician's mandatory report to NYSDOH of each prescription written under the Medical Aid in Dying Act (patient, attending, consulting physician, mental health professional and medication details).
Physician order sheet for CPR, scope of treatment, antibiotics and nutrition under N.C.G.S. 90-21.17, honored across settings and by EMS.
Electronic death registration system in which North Carolina medical certifiers complete the cause-of-death certification.
Portable out-of-hospital DNR order directing that CPR not be initiated, honored by EMS statewide (N.C.G.S. 90-21.17).
Portable medical order for CPR, treatment intensity and nutrition for people with serious illness or frailty; signed forms are submitted to the Oregon POLST Registry.
Reports the circumstances of death (ingestion of DWDA medication or other cause), complications and end-of-life care of a patient who received a DWDA prescription.
Documents the attending physician's compliance with each step of the Oregon Death with Dignity Act (terminal diagnosis, capability, oral and written requests, consultations) when a lethal-dose prescription is written.
Consulting physician confirms the terminal diagnosis, prognosis, capability and voluntariness of a patient requesting medication under the Death with Dignity Act.
Psychiatrist or psychologist reports whether a Death with Dignity patient has a psychiatric or psychological disorder or depression causing impaired judgment.
Bright pink portable medical order for CPR, medical interventions and nutrition for seriously ill Pennsylvanians.
Statutory out-of-hospital DNR order (20 Pa.C.S. 5481-5488) directing EMS not to provide CPR, optionally with a DNR bracelet or necklace.
Portable medical order for CPR, scope of treatment and artificial nutrition for patients with serious illness under S.C. Code Title 44 Chapter 80.
Portable medical order for patients with terminal illness covering CPR, scope of treatment and nutrition.
Statewide electronic registrar in which Texas medical certifiers certify cause of death and fetal death records.
25 TAC §157.25(h)(2) figureStatutory standardized order (Health & Safety Code Ch. 166) directing EMS and other out-of-hospital professionals not to initiate CPR and related resuscitation.
Utah's statutory Life with Dignity Order recording CPR and treatment-intensity orders, honored by EMS and facilities (Utah Admin. Code R432-31).
Combined out-of-hospital DNR order and clinician orders for life-sustaining treatment (18 V.S.A. 9708), honored by EMS and facilities.
Consulting physician confirms diagnosis, prognosis and capacity for a patient under Vermont's Patient Choice at End of Life law.
Prescribing physician reports compliance with Vermont's Patient Choice at End of Life law (18 V.S.A. Chapter 113) after writing a prescription.
Prescribing physician reports whether the patient ingested the medication and the circumstances of death.
Online death registration module of the Virginia Vital Events and Screening Tracking System (VVESTS) where physicians and medical certifiers complete the medical certification of attended deaths and fetal deaths.
Physician's (or authorized NP/PA) written order under Va. Code 54.1-2987.1 to withhold CPR, honored by EMS and all qualified health care personnel in any setting.
Physician-signed portable medical order for CPR and treatment intensity; Virginia adopted the National POLST form, which is honored as a Durable DNR (12VAC5-66).
Portable medical order for CPR, treatment intensity and nutrition for seriously ill or frail Washingtonians, honored by EMS.
Web system in which medical providers, medical examiners and coroners must register and complete the medical portion of Washington death and fetal death records.
Documents the attending qualified medical provider's compliance with the Washington Death with Dignity Act when a lethal-dose prescription is written.
Consulting provider confirms diagnosis, prognosis, competence and voluntariness of a patient requesting medication under the Death with Dignity Act.
Psychiatric or psychological provider reports whether a Death with Dignity patient's judgment is impaired by a mental disorder.
Reports the death and circumstances after a patient who received a Death with Dignity prescription ingests it or dies of another cause.
Portable medical order for CPR, scope of treatment and nutrition honored by all health care professionals including EMS (W. Va. Code 16-30-25).
Out-of-hospital DNR order issued on an orange card, honored by EMS and other providers.
Emergency Care Do Not Resuscitate Order (DNR), Spanish
Out-of-hospital DNR order that, with a Wisconsin DNR bracelet, directs EMS not to resuscitate (Wis. Stat. ch. 154).
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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No. National POLST says only state-developed and approved forms are valid, so the generic file is a template. Alabama, Arizona, Maine and Virginia use the National POLST form, and Virginia honors it as a Durable DNR. Texas has no POLST statute, so its standard portable order is the Out-of-Hospital DNR. Florida's POLST is voluntary and maintained by FMDA, and EMS DNR there requires DH Form 1896.
In some states, yes. North Carolina's MOST must be printed on Pulsar Pink paper and its DNR order on goldenrod. Florida's DNRO must be on yellow paper, and EMS only has to honor yellow forms. Arizona's Prehospital Medical Care Directive is orange by statute. California recommends bright pink but accepts any color, New York dropped the pink requirement, and Washington honors any color.
In each state's electronic death registration system, which follows the medical certifier items on the U.S. Standard Certificate of Death. New York uses DAVE outside New York City and eVital inside it. Maine uses DAVE, Indiana DRIVE, North Carolina NCDAVE, Texas TxEVER, Virginia VVESTS and Washington WHALES, where records must be completed within 5 days. The NCHS 2023 Physician's Handbook explains each item.
Deadlines vary by state. Oregon's attending physician sends the compliance form within 7 calendar days of the prescription and the follow-up within 10 days of ingestion or death. New York's MAID Reporting Form is filed online within five days. California, Washington and New Mexico allow 30 days from the prescription, and California files through the CDPH Online Portal, mail or fax. Hawaii also requires a counseling provider's determination for every patient.