Missouri's Transportable Physician Orders for Patient Preferences (TPOPP) Form

A TPOPP form describes your wishes for health care in a medical emergency.

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You may have heard about a new kind of health care directive in Missouri, called a Transportable Physician Orders for Patient Preferences (TPOPP) form. Here, we discuss what a TPOPP form is and when you might need one.

What Is a TPOPP Form?

A TPOPP form is a doctor’s order that helps you keep control over medical care at the end of life. Like a Do Not Resuscitate (DNR) order, a TPOPP form tells emergency medical personnel and other health care providers whether or not to administer cardiopulmonary resuscitation (CPR) in the event of a medical emergency. A TPOPP form may be used in addition to -- or, sometimes, instead of -- a DNR order. The TPOPP form may also provide other information about your wishes for end-of-life health care, as explained below.

How to Make a TPOPP Form

In Missouri, TPOPPs are currently available at some large medical facilities in metropolitan areas, including Kansas City. Efforts are underway to make the form available statewide as soon as possible. Until the form is more broadly available, you may ask a health care professional to help you make one only if you enter a participating medical facility or health care setting.

To be valid, a TPOPP must be signed by:

  • you or your legally appointed health care decisionmaker, and
  • your doctor.

In Missouri, a TPOPP form is printed on bright pink paper so it will easily stand out in your medical records. The form travels with you if you move from one health care setting to another. You can change it or cancel it at any time.

How Does a TPOPP Form Differ From Other Health Care Directives?

A TPOPP form differs from a DNR order in one important way: A TPOPP form also includes directions about life-sustaining measures in addition to CPR, such as intubation and feeding tubes. The TPOPP form helps medical providers understand your wishes for end-of-life care at a glance, but it is not a substitute for a properly prepared living will and durable power of attorney for health care.

Taken together, a living will and durable power of attorney for health care provide more information than a TPOPP form, including details about your health care agent, more complete health care wishes, and your preference for organ donation. Therefore, if you have a TPOPP form, you do not need a DNR order, but you should still complete additional health care directives to provide a full set of wishes about your care.

Which Health Care Directives Do You Need?

You need to consider a TPOPP only if you're facing a life-threatening medical condition. If you're healthy, you need only a living will and a durable power of attorney for health care decisions to provide a full set of wishes for your treatment in the event of an unexpected accident or medical crisis.

On the other hand, a patient diagnosed with a terminal illness or frailty that requires care in a medical setting -- or ongoing care at home -- may benefit from a TPOPP in addition to traditional health care directives. That’s because a living will and health care power of attorney may not be enough to prevent medical personnel from resuscitating a patient in an emergency. For that, it's important to have a medical order such as a TPOPP or DNR order. If you feel strongly that you don’t want emergency measures at the end of life -- or if you’re caring for someone who feels that way -- find out whether the TPOPP is available in your area, and consider making one in addition to traditional health care directives.

For details about preparing health care directives, see Missouri Living Wills and Durable Powers of Attorney for Health Care: What You Need to Know.

For More Information

To learn more about the Missouri TPOPP form, contact the Center for Practical Bioethics. Because it's the same as the form under development in Kansas, you can view a sample TPOPP by visiting TPOPP Wichita.

For general information about how to document your health care wishes, see the Living Wills & Medical Power of Attorney section of Nolo.com.

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