State forms

Free living will and health care power of attorney forms by state

These are the official living will and health care power of attorney forms for each state, or the best free form when a state does not publish one. Each entry also names that state's DNR / POLST forms and how to get them from your clinician. A video of your wishes complements these documents. It does not replace them.

DNR, MOST, and POLST forms

A DNR order, or a POLST-type form (called MOST, MOLST, POST, and other names depending on the state), is a medical order. It tells paramedics and other care teams what to do if your heart stops or you become very ill.

It is different from a living will. It has to be signed by a doctor, nurse practitioner, or physician assistant. You get it from your clinician, so bring it up at your next visit. You can't just download and fill it out yourself.

A video or app recording isn't a medical order. Keep the signed original where EMS will find it, for example on the fridge or by the bed, and bring it with you to the hospital.

You can change your mind at any time by talking with your clinician.

DNR / POLST forms Living will forms by state

Jump to a state

AlabamaAL
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Directive for Health Care (Living Will and Health Care Proxy)
One form covers both.
Source: Alabama Department of Public Health
Witnesses and notary: Two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Alabama Portable Physician Do Not Attempt Resuscitation (DNAR) Order
Get it from your clinician.
Alabama official information Opens in a new tab.
AlaskaAK
Living will and health care power of attorney Opens in a new tab.
Advance Health Care Directive
One form covers both.
Source: Alaska Legislature (AS 13.52.300 optional form)
Witnesses and notary: Two qualified witnesses or Alaska notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Alaska POLST (Provider Orders for Life Sustaining Treatment)
Get it from your clinician.
Alaska official information Opens in a new tab.
ArizonaAZ
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Living Will (End of Life Care); Health Care Power of Attorney; Mental Health Care Power of Attorney
Source: Arizona Attorney General
Witnesses and notary: One adult witness OR a notary (not both)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Prehospital Medical Care Directive (DNR)
- Arizona POLST (Portable Medical Orders)
Get it from your clinician.
Arizona official information Opens in a new tab.
ArkansasAR
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Advance Care Plan; Appointment of Health Care Agent
Source: Arkansas Department of Health
Witnesses and notary: Two witnesses or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- AR POLST (Physician Orders for Life-Sustaining Treatment)
- EMS Do Not Resuscitate (EMS/DNR) Order
Get it from your clinician.
Arkansas official information Opens in a new tab.
CaliforniaCA
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Health Care Directive (Probate Code §4701)
One form covers both.
Source: California Attorney General
Witnesses and notary: Two qualified witnesses or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- California POLST (Physician Orders for Life-Sustaining Treatment)
- EMSA/CMA Prehospital Do Not Resuscitate (DNR) Form
Get it from your clinician.
California official information Opens in a new tab.
ColoradoCO
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Declaration as to Medical or Surgical Treatment (Living Will); Medical Durable Power of Attorney
Living will source: Colorado Bar Association. Health care power of attorney source: Colorado Hospital Association / Colorado Advance Directives Consortium.
Witnesses and notary: Living will: two witnesses; notary optional
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Colorado MOST (Medical Orders for Scope of Treatment)
- CPR Directive
Get it from your clinician.
Colorado official information Opens in a new tab.
ConnecticutCT
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Living Will or Health Care Instructions; Appointment of Health Care Representative; Advance Directives Combined Form
Source: Connecticut Attorney General
Witnesses and notary: Two witnesses; optional notarized witness affidavit
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Connecticut MOLST (Medical Orders for Life-Sustaining Treatment)
- DNR bracelet (out of facility) / DPH DNR Transfer Form (interfacility)
Get it from your clinician.
Connecticut official information Opens in a new tab.
DelawareDE
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Health-Care Directive
One form covers both.
Source: Delaware Health and Social Services (DSAAPD)
Witnesses and notary: Two qualified witnesses; notary not required
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- DMOST (Delaware Medical Orders for Scope of Treatment)
Get it from your clinician.
Delaware official information Opens in a new tab.
District of ColumbiaDC
Living will Opens in a new tab.
Health care power of attorney Opens in a new tab.
Declaration (living will); Durable Power of Attorney for Health Care
Living will source: DC Council – Code of the District of Columbia (§7-622). Health care power of attorney source: DC Council – Code of the District of Columbia (§21-2207).
Witnesses and notary: Two adult witnesses (both documents)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- DC MOST (Medical Orders for Scope of Treatment)
Get it from your clinician.
District of Columbia official information Opens in a new tab.
FloridaFL
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Living Will; Designation of Health Care Surrogate
Source: Florida Agency for Health Care Administration (FloridaHealthFinder)
Witnesses and notary: Two adult witnesses; at least one not spouse/blood relative
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Do Not Resuscitate Order (DNRO), DH Form 1896
- Florida POLST (FMDA)
Get it from your clinician.
Florida official information Opens in a new tab.
GeorgiaGA
Living will and health care power of attorney Opens in a new tab.
Georgia Advance Directive for Health Care
One form covers both.
Source: Georgia DHS Division of Aging Services
Witnesses and notary: Two witnesses (18+)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Georgia POLST (Physician Orders for Life-Sustaining Treatment)
- Order Not to Resuscitate (O.C.G.A. 31-39)
Get it from your clinician.
Georgia official information Opens in a new tab.
HawaiiHI
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Health Care Directive
One form covers both.
Source: Hawaii Executive Office on Aging
Witnesses and notary: Two qualified witnesses or notary (choose one)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Hawaii POLST (Provider Orders for Life-Sustaining Treatment)
- Comfort Care Only - Do Not Resuscitate (CCO-DNR)
Get it from your clinician.
Hawaii official information Opens in a new tab.
IdahoID
Living will and health care power of attorney (PDF) Opens in a new tab.
Living Will and Durable Power of Attorney for Health Care
One form covers both.
Source: Idaho Attorney General
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Idaho POST (Physician Orders for Scope of Treatment)
Get it from your clinician.
Idaho official information Opens in a new tab.
IllinoisIL
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Living Will Declaration; Illinois Statutory Short Form Power of Attorney for Health Care
Source: Illinois Department of Public Health
Witnesses and notary: POA: one qualified witness, no notary; Living will: two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- IDPH Uniform POLST (Practitioner Orders for Life-Sustaining Treatment)
Get it from your clinician.
Illinois official information Opens in a new tab.
IndianaIN
Living will and health care power of attorney (PDF) Opens in a new tab.
Indiana Advance Directive (Health Care Representative appointment and preferences)
One form covers both.
Source: Indiana Patient Preferences Coalition (linked from Indiana Dept of Health)
Witnesses and notary: Two adult witnesses or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Indiana POST (Physician Orders for Scope of Treatment)
- Out of Hospital Do Not Resuscitate Declaration and Order (State Form 49559)
Get it from your clinician.
Indiana official information Opens in a new tab.
IowaIA
Living will Opens in a new tab.
Health care power of attorney Opens in a new tab.
Declaration Relating to Use of Life-Sustaining Procedures (Living Will); Durable Power of Attorney for Health Care Decisions
Living will source: Iowa State Bar Association (Form 122). Health care power of attorney source: Iowa State Bar Association (Form 121).
Witnesses and notary: Two witnesses or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- IPOST (Iowa Physician Orders for Scope of Treatment)
- Out-of-Hospital Do-Not-Resuscitate Order (IAC 641-142)
Get it from your clinician.
Iowa official information Opens in a new tab.
KansasKS
Living will Opens in a new tab.
Health care power of attorney Opens in a new tab.
Declaration (living will); Durable Power of Attorney for Health Care Decisions
Living will source: Kansas Revisor of Statutes (K.S.A. 65-28,103). Health care power of attorney source: Kansas Legislature (K.S.A. 58-632).
Witnesses and notary: Two qualified witnesses or notary (both)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- TPOPP (Transportable Physician Orders for Patient Preferences)
- Pre-Hospital Do Not Resuscitate Directive (K.S.A. 65-4942)
Get it from your clinician.
Kansas official information Opens in a new tab.
KentuckyKY
Living will and health care power of attorney (PDF) Opens in a new tab.
Living Will Directive; Health Care Surrogate Designation
One form covers both.
Source: Kentucky Attorney General
Witnesses and notary: Two witnesses (18+) or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Kentucky MOST (Medical Orders for Scope of Treatment)
- Kentucky EMS Do Not Resuscitate (DNR) Order
Get it from your clinician.
Kentucky official information Opens in a new tab.
LouisianaLA
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Declaration (Living Will); Health Care Power of Attorney
Living will source: Louisiana Secretary of State. Health care power of attorney source: Louisiana Governor's Office of Elderly Affairs (Statewide Elder Law Task Force guide).
Witnesses and notary: Living will: two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- LaPOST (Louisiana Physician Orders for Scope of Treatment)
Get it from your clinician.
Louisiana official information Opens in a new tab.
MaineME
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Health Care Directive
One form covers both.
Source: Maine Legislature (18-C M.R.S. §5-805 optional form)
Witnesses and notary: Two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Maine POLST
- Maine EMS Comfort Care/Do-Not-Resuscitate Order
Get it from your clinician.
Maine official information Opens in a new tab.
MarylandMD
Living will and health care power of attorney (PDF) Opens in a new tab.
Maryland Advance Directive: Planning for Future Health Care Decisions
One form covers both.
Source: Maryland Office of the Attorney General (hosted by Maryland Dept of Health)
Witnesses and notary: Two witnesses; notary not required
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Maryland MOLST (Medical Orders for Life-Sustaining Treatment)
Get it from your clinician.
Maryland official information Opens in a new tab.
MassachusettsMA
Living will, from CaringInfo (PDF) Opens in a new tab.
Health care power of attorney Opens in a new tab.
Health Care Proxy; (no statutory living will)
This state has no official living will form online.
Living will source: CaringInfo (no state living will statute or form). Health care power of attorney source: Mass.gov.
Witnesses and notary: Proxy: two adult witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Massachusetts MOLST (moving to the National POLST model)
- Comfort Care/DNR (CC/DNR) Order Verification Form
Get it from your clinician.
Massachusetts official information Opens in a new tab.
MichiganMI
Living will and health care power of attorney, from CaringInfo (PDF) Opens in a new tab.
Patient Advocate Designation; (no statutory living will)
One form covers both.
This state has no official state form online.
Source: CaringInfo
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- MI-POST (Michigan Physician Orders for Scope of Treatment, MDHHS-5836)
- Michigan Do-Not-Resuscitate Order (MCL 333.1054)
Get it from your clinician.
Michigan official information Opens in a new tab.
MinnesotaMN
Living will and health care power of attorney (PDF) Opens in a new tab.
Health Care Directive
One form covers both.
Source: Minnesota Attorney General
Witnesses and notary: Notary or two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- POLST Minnesota (Provider Orders for Life-Sustaining Treatment)
Get it from your clinician.
Minnesota official information Opens in a new tab.
MississippiMS
Living will and health care power of attorney, from CaringInfo (PDF) Opens in a new tab.
Advance Health-Care Directive
One form covers both.
This state has no official state form online.
Source: CaringInfo
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Mississippi POST (Physician Orders for Sustaining Treatment)
Get it from your clinician.
Mississippi official information Opens in a new tab.
MissouriMO
Living will and health care power of attorney (PDF) Opens in a new tab.
Durable Power of Attorney for Health Care and/or Health Care Directive
One form covers both.
Source: The Missouri Bar
Witnesses and notary: Two witnesses; notary required only if DPOA (Part 1) is completed
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- TPOPP (Transportable Physician Orders for Patient Preferences)
- Outside the Hospital Do-Not-Resuscitate (OHDNR) Order
Get it from your clinician.
Missouri official information Opens in a new tab.
MontanaMT
Living will and health care power of attorney (PDF) Opens in a new tab.
My Choices Advance Directive
One form covers both.
Source: Montana Department of Justice (End-of-Life Registry)
Witnesses and notary: Witnesses; notary recommended
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Montana POLST (Provider Orders for Life-Sustaining Treatment)
Get it from your clinician.
Montana official information Opens in a new tab.
NebraskaNE
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Living Will Declaration; Power of Attorney for Health Care
Source: Nebraska DHHS State Unit on Aging
Witnesses and notary: Two witnesses or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Nebraska POLST (Provider Orders for Life-Sustaining Treatment)
Get it from your clinician.
Nebraska official information Opens in a new tab.
NevadaNV
Living will Opens in a new tab.
Health care power of attorney Opens in a new tab.
Declaration (living will); Durable Power of Attorney for Health Care Decisions
Living will source: Nevada Legislature (NRS 449A.436). Health care power of attorney source: Nevada Legislature (NRS 162A.860).
Witnesses and notary: DPOA: notary or two adult witnesses (NRS 162A.790)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Nevada POLST (Provider Order for Life-Sustaining Treatment)
- Do-Not-Resuscitate Identification (out-of-hospital)
Get it from your clinician.
Nevada official information Opens in a new tab.
New HampshireNH
Living will and health care power of attorney Opens in a new tab.
Advance Directive (Durable Power of Attorney for Health Care and Living Will)
One form covers both.
Source: NH General Court (RSA 137-J:20)
Witnesses and notary: Two witnesses or notary/justice of the peace
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- NH POLST - Medical Order (bright yellow)
- Portable DNR (P-DNR) order (bright pink) and P-DNR wallet card
Get it from your clinician.
New Hampshire official information Opens in a new tab.
New JerseyNJ
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Instruction Directive; Proxy Directive (Durable Power of Attorney for Health Care)
Source: New Jersey Department of Health
Witnesses and notary: Two adult witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- NJ POLST (Practitioner Orders for Life-Sustaining Treatment)
Get it from your clinician.
New Jersey official information Opens in a new tab.
New MexicoNM
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Health-Care Directive
One form covers both.
Source: New Mexico Aging & Long-Term Services Department
Witnesses and notary: Witnesses optional but recommended
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- NM MOST (Medical Orders for Scope of Treatment)
- New Mexico EMS Do Not Resuscitate (DNR) Order
Get it from your clinician.
New Mexico official information Opens in a new tab.
New YorkNY
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Living Will (non-statutory template); Health Care Proxy
Living will source: New York Attorney General. Health care power of attorney source: New York State Department of Health.
Witnesses and notary: Two adult witnesses; no notary needed (both)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- MOLST (Medical Orders for Life-Sustaining Treatment), DOH-5003
- Nonhospital Order Not to Resuscitate (DNR Order), DOH-3474
Get it from your clinician.
New York official information Opens in a new tab.
North CarolinaNC
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Advance Directive for a Natural Death ("Living Will"); Health Care Power of Attorney
Source: NC Secretary of State
Witnesses and notary: Two qualified witnesses AND notary (both)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- MOST (Medical Orders for Scope of Treatment)
- Portable Do Not Resuscitate (DNR) Order (the 'yellow DNR form')
Get it from your clinician.
North Carolina official information Opens in a new tab.
North DakotaND
Living will and health care power of attorney (PDF) Opens in a new tab.
Health Care Directive
One form covers both.
Source: North Dakota Health and Human Services
Witnesses and notary: Notary or two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- North Dakota POLST (Physician Orders for Life-Sustaining Treatment)
Get it from your clinician.
North Dakota official information Opens in a new tab.
OhioOH
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Living Will Declaration; Health Care Power of Attorney
Both forms are in the same file.
Source: Ohio State Bar Association
Witnesses and notary: Two eligible adult witnesses or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- State of Ohio Do Not Resuscitate Order: DNR Comfort Care (DNRCC) / DNR Comfort Care-Arrest (DNRCC-Arrest)
Get it from your clinician.
Ohio official information Opens in a new tab.
OklahomaOK
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Directive for Health Care (Living Will and Health Care Proxy)
One form covers both.
Source: Oklahoma Department of Human Services
Witnesses and notary: Two witnesses (18+)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Oklahoma POLST (Physician Orders for Life-Sustaining Treatment)
- Oklahoma Do-Not-Resuscitate (DNR) Consent Form (63 O.S. 3131.5)
Get it from your clinician.
Oklahoma official information Opens in a new tab.
OregonOR
Living will and health care power of attorney (PDF) Opens in a new tab.
Oregon Advance Directive for Health Care (OHA 3905)
One form covers both.
Source: Oregon Health Authority
Witnesses and notary: Two witnesses or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Oregon POLST (Portable Orders for Life-Sustaining Treatment, 2023 form)
Get it from your clinician.
Oregon official information Opens in a new tab.
PennsylvaniaPA
Living will and health care power of attorney Opens in a new tab.
Advance Health Care Directive (Living Will and Health Care Power of Attorney)
One form covers both.
Source: Pennsylvania General Assembly (20 Pa.C.S. §5471)
Witnesses and notary: Two witnesses (18+)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order
- Pennsylvania POLST (Pennsylvania Orders for Life-Sustaining Treatment)
Get it from your clinician.
Pennsylvania official information Opens in a new tab.
Rhode IslandRI
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Declaration (Living Will); Durable Power of Attorney for Healthcare (Statutory Form)
Source: Rhode Island Department of Health
Witnesses and notary: DPOA: two qualified witnesses or one notary; Living will: two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Rhode Island MOLST (Medical Orders for Life-Sustaining Treatment)
- COMFORT ONE (DNR)
Get it from your clinician.
Rhode Island official information Opens in a new tab.
South CarolinaSC
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Declaration of a Desire for a Natural Death; Health Care Power of Attorney
Source: SC Department on Aging
Witnesses and notary: Declaration: two witnesses + notary; HCPOA: two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- South Carolina POST (Physician Orders for Scope of Treatment), D-4061
- Emergency Medical Services Do Not Resuscitate Order, DPH 3462
Get it from your clinician.
South Carolina official information Opens in a new tab.
South DakotaSD
Living will Opens in a new tab.
Health care power of attorney, from CaringInfo (PDF) Opens in a new tab.
Living Will Declaration; Durable Power of Attorney for Health Care
This state has no official health care power of attorney form online.
Living will source: South Dakota Legislature (SDCL 34-12D-3). Health care power of attorney source: CaringInfo.
Witnesses and notary: Living will form: lines for two witnesses and a notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- South Dakota MOST (Medical Orders for Scope of Treatment)
- Comfort One (EMS CPR directive)
Get it from your clinician.
South Dakota official information Opens in a new tab.
TennesseeTN
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Directive for Health Care
One form covers both.
Source: Tennessee Department of Health
Witnesses and notary: Two witnesses or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Tennessee POST (Physician Orders for Scope of Treatment), PH-4193 (serves as the Universal DNR)
Get it from your clinician.
Tennessee official information Opens in a new tab.
TexasTX
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Directive to Physicians and Family or Surrogates (Living Will); Medical Power of Attorney Designation of Health Care Agent (MPOA)
Source: Texas Health and Human Services
Witnesses and notary: Two competent adult witnesses or notary (both)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Texas Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order
Get it from your clinician.
Texas official information Opens in a new tab.
UtahUT
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Health Care Directive
One form covers both.
Source: Utah Legislature (Utah Code 75A-9-110 optional form, eff. 1/1/2026)
Witnesses and notary: One adult witness if naming an agent
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Utah OLST (Order for Life Sustaining Treatment; formerly POLST / Life with Dignity Order)
Get it from your clinician.
Utah official information Opens in a new tab.
VermontVT
Living will and health care power of attorney (PDF) Opens in a new tab.
Vermont Advance Directive for Health Care
One form covers both.
Source: Vermont Ethics Network (administers the Vermont Advance Directive Registry)
Witnesses and notary: Two adult witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Vermont DNR/COLST (Clinician Orders for Life-Sustaining Treatment)
Get it from your clinician.
Vermont official information Opens in a new tab.
VirginiaVA
Living will and health care power of attorney Opens in a new tab.
Advance Medical Directive
One form covers both.
Source: Virginia General Assembly (Va. Code §54.1-2984)
Witnesses and notary: Two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Authorized Durable Do Not Resuscitate (DDNR) Order, EMS-7105
- Virginia POST (Physician Orders for Scope of Treatment)
Get it from your clinician.
Virginia official information Opens in a new tab.
WashingtonWA
Living will Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Health Care Directive (living will); Durable Power of Attorney for Health Care
Living will source: Washington Legislature (RCW 70.122.030). Health care power of attorney source: Washington State Medical Association.
Witnesses and notary: Two qualified witnesses or notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Washington POLST (Portable Orders for Life-Sustaining Treatment)
Get it from your clinician.
Washington official information Opens in a new tab.
West VirginiaWV
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Living Will; Medical Power of Attorney; Combined Medical Power of Attorney and Living Will
Source: West Virginia State Bar (statutory forms)
Witnesses and notary: Two witnesses and notary
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- WV POST (Physician Orders for Scope of Treatment)
- WV Do Not Resuscitate (DNR) Card
Get it from your clinician.
West Virginia official information Opens in a new tab.
WisconsinWI
Living will (PDF) Opens in a new tab.
Health care power of attorney (PDF) Opens in a new tab.
Declaration to Health Care Professionals (Living Will) F-00060; Power of Attorney for Health Care F-00085
Source: Wisconsin Department of Health Services
Witnesses and notary: Two qualified witnesses (both)
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- Emergency Care Do Not Resuscitate Order, F-44763, with DNR bracelet
Get it from your clinician.
Wisconsin official information Opens in a new tab.
WyomingWY
Living will and health care power of attorney (PDF) Opens in a new tab.
Advance Health Care Directive
One form covers both.
Source: Wyoming Judicial Branch (hosts UW Extension guide with sample form)
Witnesses and notary: Notary or two witnesses
Backup form from CaringInfo (PDF) Opens in a new tab.
Medical orders (DNR / POLST)
- WyoPOLST (Wyoming Provider Orders for Life-Sustaining Treatment)
Get it from your clinician.
Wyoming official information Opens in a new tab.

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ArkansasAR

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LouisianaLA

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MarylandMD

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MassachusettsMA

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MichiganMI

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MississippiMS

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MissouriMO

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MontanaMT

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NebraskaNE

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NevadaNV

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New HampshireNH

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New JerseyNJ

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New MexicoNM

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New YorkNY

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North CarolinaNC

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North DakotaND

Medical orders (DNR / POLST)

OhioOH

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OklahomaOK

Medical orders (DNR / POLST)

OregonOR

Medical orders (DNR / POLST)

PennsylvaniaPA

Medical orders (DNR / POLST)

Rhode IslandRI