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IPOST - Iowa Physician Orders for Scope of Treatment

IPOST Form & Guidance

Description of the IPOST Form

The Iowa Department of Public Health was responsible for prescribing how the uniform IPOST form looks. The double-sided, one-page document allows a person to communicate their preferences for key life-sustaining treatments including: resuscitation, general scope of treatment, artificial nutrition, and more.

According to the statute, the IPOST form shall be a uniform form and shall have all of the following characteristics:

  • Patient’s name and date of birth.
  • Signed and dated by the patient or patient’s legal representative.
  • Signed and dated by the patient’s physician, advanced registered nurse practitioner, or physician assistant.
  • Signed and dated by the facilitator if the preparation of the form was done by an individual other than the patient’s physician, advanced registered nurse practitioner, or physician assistant.

The form shall include the patient’s wishes regarding the care of the patient, including but not limited to all of the following:

  • The administration of cardio pulmonary resuscitation (i.e. - what happens in circumstances where the patient has no pulse and is not breathing).
  • The level of medical interventions in the event of a medical emergency (i.e. - comfort measures only, limited interventions, or full treatment).
  • The use of medically administered nutrition by tube (i.e. - artificially administer nutrients for patients who cannot take oral nutrition or hydration by mouth).
  • The rational for the orders.