POLST cover sheets answer consumer questions at RCFEs and 2026

1. Click ‘Get Form’ to open the POLST cover sheet in the editor.
2. Begin by filling in the patient’s personal information, including last name, first name, middle name, date of birth, and medical record number if applicable.
3. In Section A, select either 'Attempt Resuscitation/CPR' or 'Do Not Attempt Resuscitation/DNR' based on the patient's wishes.
4. Proceed to Section B to choose the desired level of medical interventions: 'Full Treatment', 'Selective Treatment', or 'Comfort-Focused Treatment'.
5. In Section C, indicate preferences regarding artificially administered nutrition by selecting from the options provided.
6. Ensure that both the patient (or their legally recognized decisionmaker) and the physician sign the form for it to be valid.
7. Once completed, save your document. It is recommended to keep a copy in an easily accessible location for emergencies.

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