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Click ‘Get Form’ to open the blank post form in the editor.
Begin by filling in the patient's Last Name, First Name/Middle Initial, Date of Birth, and Last 4 SSN. Ensure accuracy as this information is crucial for identification.
In Section A, select the appropriate option regarding Cardiopulmonary Resuscitation (CPR) by checking either 'Attempt Resuscitation/CPR' or 'DO NOT Attempt Resuscitation/CPR'. Remember that if you choose to attempt CPR, you must also check 'Advanced Interventions' in Section B.
Proceed to Section B and choose one of the Medical Interventions options. Each option outlines different levels of care; ensure you select based on the patient’s needs.
Continue to Section C and indicate preferences for Artificially Administered Nutrition by checking one of the provided options.
In Section D, document discussions held with the patient or their representatives regarding goals and treatment decisions. Ensure all signatures are obtained where required.
Finally, review all sections for completeness before saving your changes. This ensures that all necessary information is captured accurately.
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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.
Whats the difference between POLST and DNR?
Yes. Your provider must sign the form in order for it to be valid. Most states, and the National POLST Form, also require the patient or the patients surrogate (or proxy, health care agent, representative) to sign as well.
Where can I get a POLST form?
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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Must be completed by a health care professional based on patient preferences, patient best interest, and medical indications. To be valid. POST must be signed
Note: This PS Form 3811-A serves to provide delivery information for a hardcopy return receipt (PS Form 3811) that was not received by the customer. It is
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