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- Click ‘Get Form’ to open it in the editor.
- Begin by filling in the patient’s personal information, including Last Name, First Name, Middle Initial, Date of Birth, and Gender. This section is crucial for identifying the individual.
- In Section A, choose between 'DNAR/Do Not Attempt Resuscitation' or 'CPR/Attempt Resuscitation'. Make sure to check only one option that aligns with the patient's wishes.
- Proceed to Section B to select medical interventions. Options include 'Comfort Measures Only', 'Limited Additional Interventions', or 'Full Treatment'. Each choice outlines different levels of care.
- In Section C, ensure that all required signatures are obtained. This includes signatures from both the physician and the patient or their legal surrogate.
- Finally, review all sections for completeness and accuracy before saving or printing the document. Ensure that any additional orders are clearly noted.
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Related links
by RB Wolf 2014 Cited by 13 While all adults are encouraged to think about and sign advance directives, POLST forms are appropriate for patients towards the end of life,Read more
The Portable Orders for Life Sustaining Treatment (POLST) form is a portable physician order form that describes the patients care directions.Read more