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Click ‘Get Form’ to open the Florida POLST form in the editor.
Begin by entering the patient's first and last name, date of birth, gender, and last four digits of their Social Security Number. This information is crucial for identifying the patient.
In section A, choose between 'Attempt Resuscitation/CPR' or 'Do Not Attempt Resuscitation/DNR' based on the patient's wishes regarding cardiopulmonary resuscitation.
Move 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, indicate preferences for artificially administered nutrition. Choose from options like long-term artificial nutrition by tube or no artificial nutrition.
Complete sections D and E if applicable, indicating any hospice or palliative care preferences.
Ensure all required signatures are obtained from both the physician and the patient or surrogate before finalizing the document.
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A POLST is more comprehensive than a Do Not Resuscitate order. A DNR is a stand-alone document that tells emergency medical personnel whether to perform CPR if your heart and breathing stop and you are unresponsive. A POLST includes your instructions about whether or not to perform CPR, but it doesnt stop there.
Are POLST forms used in every state?
POLST forms vary from state to state, and may differ in name and structure depending on which state you live inbut theyre conceptually the same across all states. Many states do not yet have a POLST form.
Where can I obtain a POLST form?
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.
Does Florida have a POLST form?
POLST should be completed only for patients with advanced frailness or advanced life-limiting illness. Must be completed by a health care professional based on medical indications, a discussion of treatment benefits and burdens, and elicitation of patient preferences. POLST must be signed by a MD/DO to be valid.
Does Florida have a DNR?
A DNR order, or a do-not-resuscitate order, is a pre-written healthcare directive made by a patient concerning life-saving medical interventions. As the name implies, DNRs in Florida tell doctors not to resuscitate the patient in certain circumstances usually if the heart stops.
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POLST Florida pdfPOLST forms by stateTexas POLST form pdfNational POLST formMissouri POLST formFlorida DNR formCalifornia POLST formMOLST form
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