A Do Not Hospitalize form is a signed medical order telling healthcare providers and emergency responders to treat a patient in their current care setting rather than send them to a hospital. It is most often used by nursing home and hospice residents who want to avoid ambulance transfers when their condition worsens. In most states, you obtain one by asking the patient’s treating physician, nurse practitioner, or physician assistant to complete a POLST form (the standardized portable medical order used for this purpose), which includes the hospitalization and transfer preferences a stand-alone DNH would cover.
What the Order Actually Does
A DNH tells staff that if the patient’s condition changes, treatment happens on-site. A nursing home resident who develops pneumonia gets antibiotics and symptom management at the facility instead of an ambulance ride to the emergency department. The order covers the range of situations that would normally trigger a transfer: infections, falls, breathing difficulties, and similar acute events.
Care does not stop under a DNH. It shifts location and often shifts emphasis toward comfort and symptom relief. Patients still receive antibiotics, fluids, pain medication, and any other treatment their facility can provide. For hospice patients, the order fits naturally with the comfort-focused approach they are already receiving.
The form can be written broadly or narrowly. Some patients refuse all transfers. Others want to stay put for gradual declines but keep the hospital option open for sudden trauma or situations the facility genuinely cannot handle. What matters is that the document reflects the patient’s actual values, worked out in conversation with the signing clinician.
One point families miss: without a written order, the default is full treatment and transport. EMS responders who arrive at a facility and find no portable medical order will provide full intervention and take the patient to the nearest emergency department. Verbal wishes, family conversations, and even a living will kept in a drawer somewhere are not enough at that moment. The order has to be signed, present, and recognizable.
How to Get One
Start with the patient’s treating clinician. A DNH is a medical order, not a form the patient fills out alone, so a physician, nurse practitioner, or physician assistant with an active treating relationship must sign it. Nursing homes and hospice programs routinely stock the relevant forms and often raise the topic at admission. If your state has a POLST program, the official form is available through the state’s POLST coalition, the state health department, or the care facility itself.1American Association of Nurse Practitioners. Issues at a Glance: Provider Orders for Life-Sustaining Treatment (POLST)
Using the state POLST form is almost always better than a stand-alone DNH document. POLST forms are brightly colored, standardized, and recognized by EMS and facility staff who are trained to follow them. The national POLST includes a section on initial treatment orders where “Comfort-Focused Treatments” specifically reflects a decision to stay out of the hospital. EMS responders look for two things on the form: the CPR preference and whether the patient wants transport.2National POLST Collaborative. National POLST Form Guide A custom form written outside that framework may not carry the same weight, especially with responders who have never seen it.
The process itself has four parts:
- A goals-of-care conversation with the clinician covering diagnosis, prognosis, and what the patient values. This is the substantive part and should not be rushed.
- Filling out the form together, including identifying information, CPR preferences, hospitalization and transfer preferences, and any additional instructions.
- Signatures from the patient (or authorized surrogate) and the signing clinician. Witnessing and notary rules vary by state; some require two witnesses, some accept a notary, some require neither beyond the two signatures.
- Distribution: a copy in the facility’s medical record, the original kept with the patient, and, in states with a POLST registry, an electronic upload so responders can find it.
Do not wait for a crisis. The conversation works best when nobody is under acute pressure, and rushed decisions made during an active decline are the ones families most often regret.
DNH Is Not the Same as DNR
These orders get confused constantly, and the difference is worth knowing before you sign anything. A Do Not Resuscitate order addresses one scenario: if the patient’s heart stops or they stop breathing, staff should not perform CPR or advanced cardiac life support. A DNH is broader: it addresses whether the patient goes to a hospital at all.
A patient can have a DNR without a DNH (no CPR, but hospitalization is fine for other conditions). A patient can have a DNH without a DNR (stay in the facility, but attempt resuscitation there if the heart stops). Many patients have both. A POLST form lets you specify both preferences on one document, which is another reason to use it rather than assembling separate paperwork.1American Association of Nurse Practitioners. Issues at a Glance: Provider Orders for Life-Sustaining Treatment (POLST)
Who Can Sign When the Patient Cannot
Any adult with decision-making capacity can request a DNH. Capacity here means understanding what the order does, what the alternatives are, and what staying out of the hospital might mean for their care. The clinician assesses this as part of the conversation.
If the patient lacks capacity, a legally designated healthcare proxy, guardian, or surrogate decision-maker can authorize the order. Surrogates are expected to use “substituted judgment”: choose what the patient would have wanted based on previously expressed values, not what the surrogate personally thinks is best. When the patient never expressed clear preferences, the surrogate acts in the patient’s best interest.
The clinician side is not a rubber stamp. The signing physician, NP, or PA is putting their name on a medical order, which requires an actual treating relationship and a genuine conversation about goals of care.
Changing or Canceling the Order
A patient with capacity can revoke or change a DNH at any time, by any means that communicates the intent. A verbal statement to a nurse is enough. Federal rules governing VA advance directives put this bluntly: a patient may revoke by “any means expressing the intent to revoke.”3eCFR. 38 CFR 17.32 – Informed Consent and Advance Directives That regulation applies to VA facilities, but the same principle runs through state advance directive law: current wishes take priority.
If the patient no longer has capacity, the healthcare proxy or guardian can modify or revoke the order, again based on what the patient would have wanted.
When you change or cancel, notify everyone involved: the attending physician, the facility, any hospice team, any specialist. Pull the old form out of the medical record and replace it with the updated version. If your state has a POLST registry, update the entry there. Leaving an outdated form in circulation is dangerous because emergency responders will follow whatever document they find.
When Family Members Disagree
Disagreement about a DNH is common. One sibling believes their parent would want to stay in the nursing home; another sees any refusal of hospital care as giving up. Conflicts sharpen when the patient can no longer speak and left nothing in writing.
When the patient’s documented wishes conflict with what a surrogate or family member wants, medical ethics guidance is clear that the patient’s documented wishes take priority. The American Medical Association’s Code of Medical Ethics directs physicians to bring in an ethics committee or other institutional resource when these conflicts arise.4American Medical Association. Advance Directives – AMA Code of Medical Ethics Most hospitals and many larger nursing homes have ethics committees that can mediate.
The prevention is the same as the recommendation for the form itself: have the conversation early, involve the whole family where possible, and put the wishes in writing before a crisis forces the choice. Naming one healthcare proxy also reduces conflict by establishing a single decision-maker rather than a committee under pressure.
Your Rights Under Federal Law
The Patient Self-Determination Act of 1990 requires every hospital, skilled nursing facility, home health agency, and hospice that participates in Medicare or Medicaid to inform patients in writing about their right to make decisions about their own medical care, including the right to accept or refuse treatment and the right to create advance directives. Facilities have to document whether a patient has an advance directive and cannot condition care on whether someone has executed one.5Office of the Law Revision Counsel. 42 US Code 1395cc – Agreements With Providers of Services
A nursing home cannot refuse to admit you because you have a DNH, and it cannot pressure you into signing one. The law also requires facilities to educate their staff and residents about advance directives. If nobody at admission mentioned any of this to you, the facility is out of step with federal participation requirements.
State laws layer on top, with their own rules about execution, witnessing, and clinician authority. If you are unsure about the specifics where you live, the facility’s social worker or patient advocate is usually the fastest source of accurate local information.