Utah POLST and DNR Forms

Portable medical orders like POLST and DNR ensure that your loved one's medical treatment and resuscitation preferences are consistently followed.

iStock Subscription
1m Read

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 Utah.

Everything you need is all in one place

Helpful app simplifies family caregiving by combining your loved one’s insurance benefits and medical records into one user-friendly platform while enhancing your caregiving skills

Get started for free

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.

UTAH POLST

English (fillable) || Spanish (fillable)

UTAH DNR

English (fillable) - The DNR has been replaced by POLST (same document as above)

RESOURCES

UT POLST

eForms - UT DNR (Electronic Forms LLC, 2023)

National POLST Site

National POLST Map (click on your state)

While the documents contained here are binding when properly executed, no content in this app, regardless of date, should ever be used as a substitute for any direct medical guidance you receive from your provider or other qualified medical professionals.

Likewise, no content in this app, regardless of date, should ever be used as a substitute for any direct legal advice you receive from your lawyer or other qualified legal professionals.

Go to all guides

About us

Helpful is an app to make caregiving easier. We integrate your loved one’s insurance benefits, medical records and caregiving guides into an immediate, accessible and user-friendly experience. Helpful supports your care needs by eliminating administrative tasks and providing technology to support your caregiving experience.

Get started for free