Polst form utah 2025

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The document is a Physician Order for Life Sustaining Treatment (POLST) from the Utah Department of Health, designed to outline patient preferences regarding life-sustaining treatments based on their wishes and medical conditions. It includes sections for resuscitation orders, treatment options when the patient is breathing, antibiotic use, and artificial nutrition and hydration. The form must be signed by both the patient and physician, with specific instructions for care providers to follow in various medical scenarios. It emphasizes the importance of reviewing and updating the order as the patient's health status changes.

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Click ‘Get Form’ to open the POLST form in our editor.
Begin by entering the patient's last name, first name, and date of birth at the top of the form. This information is crucial for identifying the patient.
In Section A, choose between 'Attempt to resuscitate' or 'Do not attempt resuscitation (DNR)'. If you have additional instructions, provide them in the space provided.
Move to Section B and select one of the treatment options based on whether the patient has a pulse and is breathing. Ensure you include any specific instructions as needed.
Continue through Sections C, D, and E, checking all applicable options regarding antibiotics, artificially administered fluids, nutrition, and discussions with relevant parties.
Finally, ensure that all required signatures are obtained at the bottom of the form. This includes signatures from both physicians if applicable.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are the three types of advance directives?

Because the purpose of a health care power of attorney is different from that of an advance directive, a health care agent usually do not have the authority to change or revoke the advance directives of the person they represent.

Is an advance directive the same as a POLST form?

An advance directive is a direction from the patient, not a medical order. In contrast, a POLST form consists of a set of medical orders that applies to a limited population of patients and addresses a limited number of critical medical decisions.

What is the single critical difference between an advance medical directive and a POLST document?

Advance Directives: POLSTs give specific directions about treatments during an emergency if you cannot speak for yourself. However, POLSTs do not appoint someone to speak on your behalf (surrogate or health care agent) which Advance Directives generally do.

Is a POLST different from an advance directive?

You do not need an attorney to complete the form. The form also does not have to be notarized. You do need a disinterested witness. You can find the form for the Utah Advance Healthcare Directive and instructions for completing it at .

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