Home
Forms Library
What is polst form california pdf

Polst form 2025

what is polst form california pdf Preview on Page 1

See details

4.4 out of 5

50 votes

The 2011 California POLST Form is a legal document that outlines a patient's preferences for life-sustaining treatment based on their medical condition and wishes. It includes options for cardiopulmonary resuscitation (CPR), medical interventions, and artificially administered nutrition. The form must be completed by a healthcare provider and signed by both the physician and the patient or their legally recognized decision-maker. It complements an Advance Directive but does not replace it, ensuring that patients are treated with dignity and respect according to their expressed desires.

Here's how it works

01. Edit your what is polst form california pdf online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out POLST form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the POLST form in the editor.
Begin by filling in the patient’s information, including their last name, first name, middle name, date of birth, and medical record number if applicable.
In Section A, select either 'Attempt Resuscitation/CPR' or 'Do Not Attempt Resuscitation/DNR' based on the patient's wishes.
Proceed to Section B to choose the desired level of medical interventions: 'Comfort Measures Only', 'Limited Additional Interventions', or 'Full Treatment'.
In Section C, indicate preferences regarding artificially administered nutrition by selecting one of the options provided.
Complete the information and signatures section by discussing with the patient or legally recognized decision-maker and obtaining necessary signatures.

Start using our platform today for free to easily fill out your POLST form!

See more polst form versions

We've got more versions of the polst form form. Select the right polst form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (42 Votes)
2011	4.4 Satisfied (50 Votes)
2009	4.7 Satisfied (28 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

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

How long is a POLST valid?

Just as with DNR orders, family members generally cannot override a patient- and physician-signed POLST order. Accordingly, all efforts should be made to get patients, families, and providers on the same page before an acute event, to prevent confusion about the plan of care and distress for families and providers.

What is the difference between a POLST and a DNR?

A POLST is a useful, but less well-known document that many caregivers dont know about. Even though they both cover end-of-life wishes, a POLST is different from a living will. A POLST is a doctors order while a living will is a legal document.

What does POLST form stand for?

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.