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POLST - POLST Form - POLST Brochure 2026

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Definition and Purpose of POLST Forms

Physician Orders for Life-Sustaining Treatment (POLST) forms are medical orders that specify the treatment preferences of individuals with serious, life-limiting illnesses or frailty. These forms guide healthcare providers in making medical decisions that align with the patient's desires during emergencies. The POLST form includes options for resuscitation, levels of medical intervention, and preferences regarding medically assisted nutrition.

Key Elements of POLST Forms

  • Resuscitation Options: Directives on whether or not to perform CPR in the event of cardiac or respiratory arrest.
  • Medical Interventions: Preferences concerning various levels of medical intervention, ranging from full treatment to palliative care only.
  • Medically Assisted Nutrition: Choices regarding long-term nutrition and hydration via medical interventions.

Steps to Complete the POLST Form

  1. Discussion with Healthcare Provider: The individual or their legal decision-maker must discuss their treatment preferences with a healthcare provider.
  2. Decision-Making: Decisions should be made collaboratively, ensuring that choices align with personal values and medical realities.
  3. Form Completion: The form is filled out with the assistance of a qualified medical professional.
  4. Signatures Required: The form must be signed by both the individual (or their legal representative) and a healthcare provider to be valid.

Legal Use and Compliance

  • POLST forms are legally recognized documents that ensure an individual's treatment preferences are followed.
  • These forms emphasize shared decision-making between patients and healthcare providers.
  • In the U.S., the POLST form is recognized across different states, though specific regulations may vary.

How to Obtain a POLST Form

Methods of Acquisition

  • Healthcare Providers: Obtain forms directly from hospitals, clinics, or other healthcare facilities.
  • Online Sources: Many states offer digital versions of the POLST form through their health department websites.
  • Legal and Medical Organizations: Access these forms through professional associations related to healthcare and legal services.

State-Specific Rules and Variations

Variations Across States

  • Regulations: Some states may have unique requirements or slight variations in the POLST form layout.
  • Recognition: While POLST is widely recognized, specifics regarding legal status and enforcement can differ.
  • Transferability: It's important to ensure forms are valid in all states where the individual may receive treatment.

Who Typically Uses POLST Forms

Target Audience

  • Patients with Serious Illnesses: Individuals with life-limiting illnesses or advanced frailty.
  • Elderly Individuals: Seniors who prefer to have predetermined treatment plans.
  • Families and Legal Representatives: Those responsible for making medical decisions on behalf of patients.

Important Terms Related to POLST

Definitions and Explanations

  • Advance Directive: Legal documents outlining a person's preferences for medical treatment, which may accompany a POLST form.
  • Durable Power of Attorney for Healthcare: A legal document that appoints someone to make healthcare decisions if a person is unable.

Online vs. Paper POLST Forms

Comparison of Formats

  • Digital Forms: Accessible online and can be integrated with electronic health records for easier sharing and updating.
  • Paper Forms: Traditional method, often used in conjunction with discussions and consultations with healthcare providers.

Collecting and Storing POLST Forms

Storage Recommendations

  • Patient Records: Ensure forms are filed within the patient’s medical records for immediate access in an emergency.
  • Residential Display: Patients often keep a copy visible at home (such as on the refrigerator) for emergency responders.
  • Digital Upload: Forms can be uploaded to electronic health record systems or patient portals for easy accessibility.

By understanding the importance, completion process, and utilization of POLST forms, individuals and families can ensure their medical treatment preferences are respected and adhered to in crucial situations.

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The POLST form should be clearly posted or maintained near the patient. It is recommended that POLST be copied on bright pink paper to help ensure that the document stands out and is followed. However, POLST on any color paper is valid.
How to Order the National POLST Form. Visit your program website or docHub 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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