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.

Providers: find MOST, POLST and DNR forms for every state here

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 formsLiving will forms by stateU.S. territories

U.S. territories

Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands. Most territories don't publish a fill-in form, so we link the law that sets the rules when there's no form.

  • Puerto RicoPR

    Living will and health care power of attorney, from CaringInfo (PDF)

    Declaración Previa de Voluntad sobre Tratamiento Médico (Advance Statement of Will Regarding Medical Treatment), with designation of a mandatario (health care agent)

    One form covers both.

    Puerto Rico has no government-published fill-in form. These are CaringInfo forms based on Ley 160-2001.

    Source: CaringInfo (Puerto Rico Advanced Statement of Will Regarding Treatment, English)

    Witnesses and notary: Sworn before a notary, or signed before a physician and two qualified witnesses (not heirs, not involved in direct care); must state date, time and place. Age 21+.

    En español: testamento vital y poder para atención médica (PDF)

    Spanish version from CaringInfo (Spanish edition of its Puerto Rico form; the governing law, Ley 160-2001, is published in Spanish) (not a government source).

    Puerto Rico law on advance directives (PDF)

    Medical orders (DNR / POLST)

    Ask your clinician whether a DNR or POLST-type order is available where you live.

  • GuamGU

    Living will: the law (no official form) (PDF)
    Health care power of attorney

    Declaration (Natural Death Act, 10 GCA §91103); Durable Power of Attorney for Health Care (no statutory form)

    Guam has no official fill-in form. The living will link is the official law with the required wording. There is no statutory health care power of attorney form.

    Living will source: Guam Compiler of Laws (10 GCA Ch. 91, Natural Death Act, statutory declaration in §91103(b)). Health care power of attorney source: Guam Elder Justice Center (health care power of attorney questionnaire).

    Witnesses and notary: Declaration: two witnesses (not heirs, not health care providers or their employees)

    Medical orders (DNR / POLST)

    Ask your clinician whether a DNR or POLST-type order is available where you live.

  • U.S. Virgin IslandsVI

    Living will: the law (no official form)
    Health care power of attorney: the law (no official form)

    Declaration Relating to Use of Life-Sustaining Treatment (19 V.I.C. §187); Appointment of Health Care Representative (19 V.I.C. §207, no statutory form)

    The U.S. Virgin Islands has no official form online. The links are the law, which includes optional sample wording for the declaration.

    Living will source: Virgin Islands Code, 19 V.I.C. §187 (optional statutory declaration forms), via Justia. Health care power of attorney source: Virgin Islands Code, 19 V.I.C. §207 (health care representative appointment), via Justia.

    Witnesses and notary: Declaration: two witnesses. Health care representative: one witness (not the representative), and the representative must accept in writing.

    Medical orders (DNR / POLST)

    Ask your clinician whether a DNR or POLST-type order is available where you live.

  • American SamoaAS

    Living will: the law (no official form)
    Health care power of attorney: the law (no official form)

    Living Will (A.S.C.A. §13.0804, no statutory form); Appointment of Health Care Representative (A.S.C.A. §13.0801, no statutory form)

    American Samoa has no official form. The links are the law that sets the signing rules.

    Living will source: American Samoa Bar Association (A.S.C.A. §13.0804). Health care power of attorney source: American Samoa Bar Association (A.S.C.A. §13.0801).

    Witnesses and notary: Both: two adult witnesses; at least one not a spouse or blood/adoptive relative; the representative cannot witness

    American Samoa law on advance directives

    Medical orders (DNR / POLST)

    Ask your clinician whether a DNR or POLST-type order is available where you live.

  • Northern Mariana IslandsMP

    Living will: the law (no official form) (PDF)
    Health care power of attorney: the law (no official form) (PDF)

    Declaration (Medical Consent Act, 3 CMC §2862)

    The Northern Mariana Islands has no official fill-in form. The link is the official law with the required declaration wording. No health care power of attorney law or form was found.

    Living will source: CNMI Law Revision Commission (3 CMC §2862, statutory declaration). Health care power of attorney source: CNMI Law Revision Commission (3 CMC §2862).

    Witnesses and notary: Declaration: two witnesses (not heirs, not health care providers or care-facility operators/employees)

    Medical orders (DNR / POLST)

    Ask your clinician whether a DNR or POLST-type order is available where you live.

Record the video that goes with the form

The form is the legal document. The video is how your family hears what you want, in your own voice. LifeWishGuardian is free on iPhone.

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