Arizona POLST Form 2026

Get Form
Arizona POLST Form Preview on Page 1

Here's how it works

01. Edit your form 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.

Definition & Meaning

The Arizona POLST Form, or Provider Orders for Life-Sustaining Treatment, is a medical order utilized in the state of Arizona to outline a patient's preferences regarding life-sustaining treatments. This form bridges the gap between patient wishes and medical actions, ensuring healthcare providers respect the individual's choices in critical healthcare situations. Unlike an advance directive, the POLST form is actionable in real-time emergencies and is intended for patients with serious illnesses or frail health, thereby enhancing urgent care situations.

How to Use the Arizona POLST Form

The Arizona POLST Form is utilized by patients and healthcare professionals to guide the management of medical treatment preferences. Primarily used for patients with advanced chronic illness or those approaching the end of life, it directs healthcare providers about the desired level of medical intervention. Patients should discuss with their healthcare provider to ensure the form accurately reflects their wishes. Completed forms must be kept accessible to emergency services and caregivers, preferably posted on the refrigerator or stored in a known location at home.

Completing the Form

  1. Discussion with Healthcare Provider: Begin with a detailed conversation with your doctor about your medical condition and treatment options.
  2. Selecting Preferences: Choose the level of intervention you desire, such as full treatment, selective treatment, or comfort-focused treatment.
  3. Signature Requirement: The form requires signatures from both the patient or their legal representative and the healthcare provider to be valid.
  4. Distribute Copies: Ensure copies of the completed form are distributed to relevant parties, including family members and medical personnel involved in your care.

How to Obtain the Arizona POLST Form

The Arizona POLST Form is typically available through healthcare providers. Patients should request this form during office visits or through hospital social work departments. The form can also be accessed through specific state healthcare websites or patient advocacy organizations that focus on end-of-life care planning.

Steps to Complete the Arizona POLST Form

Completing the Arizona POLST Form requires collaboration between the patient and healthcare provider. Detailed steps include:

  1. Patient Assessment: Evaluate eligibility and medical condition suitability for the POLST program.
  2. Review Treatment Options: Discuss all possible medical interventions and their implications.
  3. Document Preferences: Clearly outline choices regarding CPR, medical interventions, antibiotics, and artificially administered nutrition.
  4. Sign and Verify: Obtain necessary signatures from the patient and healthcare provider.
  5. Review Periodically: Reassess the POLST form periodically or after major health changes to ensure it remains up-to-date with patient wishes.

Why You Should Use the Arizona POLST Form

The Arizona POLST Form ensures that a patient's medical treatment preferences are recognized and respected across various healthcare settings. Such a form is critical for individuals with serious or chronic health conditions, as it provides clear instructions that can prevent unwanted or non-beneficial treatments. It facilitates communication between patients, families, and healthcare professionals, aligning treatment with personal values.

Who Typically Uses the Arizona POLST Form

The primary users of the Arizona POLST Form are patients with severe, life-limiting health conditions or those who are frail and elderly. These patients are at higher risk of requiring emergency medical interventions where quick decisions regarding life-sustaining treatments must be made. Healthcare providers also engage with these forms to better understand patient preferences in advance of critical situations. Family members and legal representatives may also play a role in discussions or completion if the patient is unable to express their wishes.

decoration image ratings of Dochub

Legal Use of the Arizona POLST Form

The Arizona POLST Form is recognized as a legally binding document that healthcare providers must follow. It serves as an actionable medical order rather than a suggestion, comparable to standing orders typically issued by physicians. Compliance with the POLST directives safeguards healthcare providers legally, ensuring treatments align with established patient wishes and reduce liability risks associated with unwanted medical interventions.

Key Elements of the Arizona POLST Form

The Arizona POLST Form comprises several crucial components, designed to guide healthcare providers:

  • CPR Instructions: Details whether the patient desires resuscitation in the event of cardiac arrest.
  • Medical Interventions: Specifies preferences for the intensity of medical treatments, ranging from full treatment to palliative care only.
  • Antibiotic Use: Guides choices regarding antibiotic treatments in acute scenarios.
  • Artificial Nutrition: Expresses preferences for artificial nutrition and hydration.
  • Signatures: Mandates signatures from the patient or representative and a validating healthcare provider.

Each element ensures the form is comprehensive, precise, and reflective of patient preferences, facilitating appropriate medical and care team actions.

be ready to get more

Complete this form in 5 minutes or less

Get form

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more
ccpa2
pci-dss
gdpr-compliance
hipaa
soc-compliance
be ready to get more

Complete this form in 5 minutes or less

Get form