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Click ‘Get Form’ to open the New Jersey POLST blank in the editor.
Begin by entering the person's name and date of birth at the top of the form. This information is crucial for identifying the individual.
In Section A, outline the goals of care. Consider what outcomes are most important to the person, such as quality of life or specific events they wish to attend.
Move to Section B, where you will select medical interventions. Choose between full treatment, limited treatment, or symptom treatment only based on the individual's preferences.
In Section C, indicate preferences regarding artificially administered fluids and nutrition. Ensure that these choices align with the person’s wishes.
Section D requires decisions about CPR and airway management. Clearly mark preferences for resuscitation efforts.
If applicable, designate a surrogate decision maker in Section E who can modify these orders if necessary.
Finally, ensure that a physician or APN signs in Section F to validate the document. This step is essential for compliance.
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This form, signed by a patients attending physician, advanced practice nurse or physicians assistant, provides instructions for health care personnel to follow for a range of life-prolonging interventions. Practitioner Orders for Life-Sustaining Treatment (POLST) NJ.gov health advancedirective polst NJ.gov health advancedirective polst
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. National POLST Form: Portable Medical Order National POLST national-form National POLST national-form
What makes a POLST invalid?
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. DNR And POLST Forms | EMSA Emergency Medical Services Authority - CA.gov dnrandpolstforms Emergency Medical Services Authority - CA.gov dnrandpolstforms
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POLST orders are actual orders that transfer with the person and are valid in all settings in New Jersey. It is recommended that POLST be reviewed periodically,
of over-marketing is found in New Jerseys recently enacted POLST legislation. That states law says a POLST is recommended for use by patients . who have
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