Arizona POLST and DNR Forms

Helpful Highlights

• It is strongly encouraged that you read the following Helpful content Guides before selecting a POLST and/or DNR form:

  • An Advance Directive by Any Other Name...

  • Physician Orders for Life-Sustaining Treatment (POLST)

  • Do Not Resuscitate (DNR) Order

• The signed POLST and/or DNR form must be in English.

• Below are POLST and DNR forms available in Arizona.

POLST and DNR requirements

Unlike other forms that can be self-created and legally binding POLST and DNR forms require the review and signature of a healthcare provider. The forms are invalid if not signed by a provider.

Some states simply use the National POLST form and not a POLST form specific to that state. The National POLST form is acceptable for states with POLST programs but without specific forms.

While POLST and DNR forms are available in various languages for ease of education and understanding, the signed forms must be in English.

ARIZONA POLST

(requires printing on HOT PINK paper)

English || Spanish

National POLST Form

ARIZONA DNR

(requires printing on ORANGE paper)

English (fillable)