Download the master copy POLST form for print - wsma 2025

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The document outlines the Physician Orders for Life-Sustaining Treatment (POLST), which is a voluntary set of medical orders designed to guide treatment based on a patient's current medical condition and preferences. It details options for cardiopulmonary resuscitation, medical interventions, and non-emergency treatment preferences, emphasizing the importance of dignity and respect in patient care. The POLST must be signed by a healthcare provider and the patient or their surrogate to be valid, and it allows for disclosure to other healthcare providers as necessary under HIPAA regulations.

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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.

Can I download a POLST form?

National POLST Model Form A copy of this publication may be downloaded, stored, or printed for personal use only; all other uses require written permission.

What is the difference between an advance directive and 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.

Does Washington state have a POLST registry?

The department and the Washington State Medical Association (WSMA) have implemented a Portable Orders for Life Sustaining Treatment form, which will allow a person to summarize their wishes regarding end of life treatment.

How do I get a POLST form in Washington state?

POLST forms and information brochures can be obtained from your medical provider, or you can request a POLST form by sending a self-addressed stamped envelope to: Washington State Medical Association, Attn: POLST, 2001 6th Ave., Suite 2700, Seattle, WA 98121.

Where can I obtain a POLST form?

How to Order the National POLST Form. Visit your program website or reach 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.