Guide to the Illinois DNR and POLST Form

This form allows you to clearly state your wishes for emergency care and life-sustaining treatments. It’s a medical order used by doctors and first responders to follow your preferences—especially if you’re seriously ill or nearing the end of life.

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Illinois Medical

📄 Download the Official Form

You can access the official Illinois DNR/POLST form here:

👉 Download the Illinois DNR and POLST Form (fillable PDF)

👉 Create Legal Illinois POLST Document


What Is It?

This form is both a:

Unlike a Power of Attorney for Health Care, this form contains direct medical orders and must be signed by both you (or your legal representative) and your healthcare provider.


When Should I Use It?

Use this form if:

It is especially important for people with:


What Does It Cover?

The DNR/POLST form allows you to specify:

All instructions on this form are meant to be followed immediately by EMTs, emergency room staff, and all healthcare providers.


Who Needs to Sign It?

The form must be signed by:

No witness or notary is required.


What Do I Do With the Form?

Tip: Ask your doctor to add it to your electronic medical record.


Can I Change My Mind?

Yes. You can revise or cancel your DNR/POLST at any time.


DNR/POLST vs. Power of Attorney for Health Care

Form

What It Does

DNR/POLST

Directs emergency and medical staff to follow specific treatment preferences

POA-HC

Appoints a person to make health decisions on your behalf if you're unable

These two forms work well together. A POA ensures someone speaks for you; a DNR/POLST ensures your treatment instructions are followed.

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