Polst form hawaii 2026

The document outlines the Provider Orders for Life-Sustaining Treatment (POLST) in Hawai‘i, detailing the necessary signatures and medical orders regarding resuscitation, artificial nutrition, and other medical interventions based on patient preferences. It emphasizes the importance of aligning treatment with the patient's wishes or those of a legally authorized representative, while also providing guidelines for healthcare professionals on completing and using the POLST form.

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Click ‘Get Form’ to open the POLST form in our editor.
Begin by filling in the patient’s last name, first/middle name, and date of birth at the top of the form. This information is crucial for identifying the patient.
In Section A, indicate the desired resuscitation preferences by checking the appropriate box. Options include 'Attempt Resuscitation' or 'Do Not Attempt Resuscitation.'
Proceed to Section B to specify medical interventions. Choose between 'Comfort Measures Only,' 'Limited Additional Interventions,' or 'Full Treatment' based on the patient's wishes.
In Section C, decide on artificial nutrition and hydration preferences. Indicate if food and liquid should be offered by mouth or if artificial nutrition is desired.
Ensure that both the patient (or their legally authorized representative) and a licensed provider sign the form in the designated areas to validate it.

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