Polst form utah 2026

1. Click ‘Get Form’ to open the POLST form in the editor.
2. Begin by entering the patient's last name, first name, middle initial, and date of birth at the top of the form.
3. In Section A, select one option regarding resuscitation preferences: either 'Attempt to resuscitate' or 'Do not attempt or continue any resuscitation (DNR)'. Provide any additional instructions if necessary.
4. Proceed to Section B and choose from three treatment options based on whether the patient has a pulse and is breathing. Include any clarifications as needed.
5. In Sections C and D, indicate preferences for antibiotics and artificially administered fluids/nutrition by checking applicable boxes. Add further instructions if required.
6. Complete Sections E and F by discussing with relevant parties and documenting their names and contact information. Ensure all signatures are obtained where necessary.

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