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Bureau of Emergency Medical Services and Preparedness

Utah Department of Health

Advance Care Directives

A “Provider Order for Life Sustaining Treatment” (POLST), or “Life With Dignity Order,” is a physician order sheet based on patient wishes and medical indications for life-sustaining treatment. It is sometimes referred to as a “Do Not Resuscitate” (DNR) form, but it is more comprehensive. POLST forms are maintained by the Bureau of Health Facility Licensing, Certification and Resident Assessment and are used by EMS and other medical personnel when making treatment decisions.

The POLST/Life with Dignity Provider Guide explains the purpose, background, and proper utilization of the POLST/Life with Dignity Order Form and may be useful to answer questions about the best use of the POLST/Life with Dignity Order.

Downloadable Forms

Questions? Contact Peter Taillac, ptaillac@utah.gov or 801-273-6646.