POLST - POLST Form - POLST Brochure 2025

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The document outlines the Physician Orders for Life-Sustaining Treatment (POLST), a voluntary medical order that allows individuals to specify their preferences for medical interventions in critical situations. It details options for resuscitation, levels of medical intervention, and preferences regarding medically assisted nutrition. The POLST must be completed with a healthcare professional and signed by both the individual or their legal decision maker and a qualified medical provider. It emphasizes the importance of shared decision-making and the need to review the POLST regularly as health conditions change.

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What is the difference between POLST and DNR?

A POLST is more comprehensive than a Do Not Resuscitate order. A DNR is a stand-alone document that tells emergency medical personnel whether to perform CPR if your heart and breathing stop and you are unresponsive. A POLST includes your instructions about whether or not to perform CPR, but it doesnt stop there.

What does a POLST form consist of?

POLST forms are medical orders that your provider uses to tell another provider what treatments you want when you cannot speak for yourself. Since the POLST form is how your provider tells another provider what you want, the words and phrases on the form use medical terminology.

What is a POLST form used for?

POLST or POST (physician/provider orders for life-sustaining treatment). MOLST (medical orders for life-sustaining treatment). COLST (clinician orders for life-sustaining treatment). MOST (medical order for scope of treatment).

Is a POLST form the same as a DNR?

Like a DNR, a POLST form lets EMS know whether or not the patient wants CPR. DNR orders only apply when a person does not have a pulse, is not breathing and is unresponsive. However, in most medical emergencies, a person does have a pulse, is breathing or is responsive. Thats where POLST is different.

Where can I obtain a POLST form?

How to Order the National POLST Form. Visit your program website or reach out to your program contact to order POLST forms. Forms are not available to individuals since they are medical orders that should be completed by providers.

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What is the difference between a POLST and a MOLST?

A POLST is a portable medical order written and signed by a doctor on your behalf. Depending on the state you live in, it might be called something else. These names are interchangeable and can include: MOLST Medical Orders for Life-Sustaining Treatment.