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Polst form hawaii 2026
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- Click ‘Get Form’ to open the POLST form in our editor.
- Begin by entering the patient's First and Last Name, Date of Birth, and the Date Form Prepared in Section A. This information is crucial for identifying the patient.
- In Section B, select one of the options regarding Cardiopulmonary Resuscitation (CPR). Choose between 'Attempt Resuscitation/CPR' or 'Do Not Attempt Resuscitation/DNAR' based on the patient's wishes.
- Next, indicate the desired Medical Interventions by checking one option: 'Comfort Measures Only', 'Limited Additional Interventions', or 'Full Treatment'. Each option outlines different levels of care.
- Proceed to Section C to specify preferences for Artificially Administered Nutrition. Choose from 'No artificial nutrition by tube', 'Long-term artificial nutrition by tube', or a defined trial period.
- In Section D, ensure that signatures are obtained from both the Provider and the Patient or their Legally Authorized Representative. This validates the orders outlined in the form.
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