Oregon Do Not Resuscitate (DNR) Form – Sample

Oregon Do Not Resuscitate (DNR) Form – Sample

An Oregon do not resuscitate form is used to instruct health care professionals on whether to attempt CPR or apply other life-sustaining measures. Oregon uses the Portable Orders for Life-Sustaining Treatment (POLST) program, which offers additional information regarding interventions when the patient has a pulse and is breathing.

Last updated July 4th, 2025

An Oregon do not resuscitate form is used to instruct health care professionals on whether to attempt CPR or apply other life-sustaining measures. Oregon uses the Portable Orders for Life-Sustaining Treatment (POLST) program, which offers additional information regarding interventions when the patient has a pulse and is breathing.

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Signing Requirements

An Oregon POLST must be signed by one of the following medical professionals[1]:

  • Physician
  • Naturopathic physician
  • Physician assistant
  • Nurse

Order POLST Forms

In Oregon, only health care professionals can order POLST forms, and may do so from the Oregon POLST website.

Sources

  1. ORS 127.663(7)