POLST for Patients

If you are seriously ill, you may want to make decisions about life-sustaining treatment before you are no longer able to do so. Once these wishes have been discussed with your physician, they can be transformed into actual physician orders called Physician Orders for Life-Sustaining Treatment, or POLST.

POLST can provide security for you and your physician that your wishes will be carried out. The form will remain with you if you are transported between care settings, regardless of whether you are in the hospital, at home or in a long-term care facility. There is no other form that streamlines the process in this way.

POLST must be signed by both the patient and the attending physician, nurse practitioner or physician assistant-certified. The attending physician, ARNP or PA-C who signs the form assumes full responsibility for its accuracy.

Learn more about POLST:

What is the POLST form?
What are my options for life-sustaining treatment?
What information is included on the POLST form?
Does a POLST form limit the type of treatment I can get?
Is POLST required by law?
Who would benefit from having a POLST form?
Does the POLST form replace traditional advance directives?
If someone has a POLST form and an advance directive that conflict, which takes precedence?
Who completes the POLST form?
What if my loved one can no longer communicate her/his wishes for care?
What happens to my POLST form after it is completed and signed?
Can I change my POLST form?
What happens if I don’t have a POLST form?
Are faxed copies and/or photocopies valid? Must green paper be used?
How can I get a POLST form?
Where do they use POLST now?
What if I travel to another state? Will my POLST form be valid?
What if I move to another state—will my POLST be valid?



What is the POLST form?

POLST form POLST is a physician order that helps give seriously ill patients more control over their end-of-life care. Produced on distinctive bright green paper and signed by both the clinician and patient, POLST specifies the types of medical treatment that a patient wishes to receive toward the end of life. As a result, POLST can prevent unwanted or medically ineffective treatment, reduce patient and family suffering, and help ensure that patients’ wishes are honored.

What are my options for life-sustaining treatment?

You have the power to determine the kind of treatments you want to receive and the kind of treatments you want to avoid. To help you understand your options, visit the new Honoring Choices Pacific Northwest website for information that will help you begin these conversations with your family and health care professionals.

What information is included on the POLST form?

The decisions documented on the POLST form include whether to:

  • Attempt cardiopulmonary resuscitation (CPR).
  • Administer antibiotics and IV fluids.
  • Use a ventilator to help with breathing.
  • Provide artificial nutrition by tube.

Does a POLST form limit the type of treatment I can get? What if I get a simple infection?

POLST gives you more control over receiving treatments you want to receive and avoiding treatments you do not want to receive in the event you are unable to speak for yourself during a medical emergency. If you want everything possible done during a medical emergency, then your health care professional would complete the form showing “CPR” and “Full Treatment.” Conversely, if you want other treatment, your health care professional would complete the form showing “Comfort Measures Only” or “Limited Treatment.”

Additionally, POLST states that ordinary measures to improve the patient’s comfort, and food and fluid by mouth as tolerated, are always provided.

Is POLST required by law?

No. Completing a POLST form should always be voluntary. If someone is being forced to complete a form, contact the WSMA POLST program at gfs@wsma.org.

Who would benefit from having a POLST form?

POLST is not for everyone. POLST is designed for seriously ill individuals, or those who are in very poor health, regardless of their age.

Most people are too healthy to need a POLST. If something suddenly happened, many healthy seniors would want everything done while more was learned about what was wrong and about their chances of recovery. Healthy people should have an advance directive. Later, if the patient became sicker or frailer, they or their surrogate (for example, their power of attorney for health care) can complete a POLST to turn their treatment wishes into medical orders.

Does the POLST form replace traditional advance directives?

POLST complements an advance directive and is not intended to replace that document. An advance directive is still necessary to appoint a legal health care decision maker, and is recommended for all adults, regardless of their health status.

If someone has a POLST form and an advance directive that conflict, which takes precedence? If there is a conflict between the documents, the more recent document would be followed.

Who completes the POLST form?

A health care professional, usually a doctor, nurse, physician assistant or social worker, completes the form after having a conversation with the patient to understand his/her wishes and goals of care. Once completed, POLST must be signed by both the patient and either their doctor, a nurse practitioner (ARNP) or a physician assistant-certified (PA-C). The doctor, nurse or physician assistant that signs the form assumes full responsibility for its accuracy.

Patients should not be provided a POLST form to complete on their own. A POLST form should never be completed without a conversation with the patient, or his/her surrogate, about diagnosis, prognosis, treatment options and goals of care.

What happens to my POLST form after it is completed and signed?

What if my loved one can no longer communicate her/his wishes for care? A health care professional can complete the POLST form based on family members’ understanding of their loved one’s wishes. The appointed surrogate decision maker can then sign the POLST form on behalf of their loved one.

The original POLST form, on bright green paper, stays with you at all times. In a hospital, nursing home or assisted living facility, the form will be in your medical record or file. If at home, place your form in a visible location so it can be found easily by emergency medical personnel, usually on a table near your bed, or on the refrigerator.

Can I change my POLST form?

Yes, you can change your POLST at any time should your preferences for treatment change. It is a good idea to review the decisions on your POLST form when any of the following occur:

  • You are transferred from one setting to another—for example you go from your home to the hospital, or you are discharged from the hospital to a nursing home.
  • There is a change in your overall health, or you are diagnosed with an illness.
  • Your treatment preferences change for any reason.

What happens if I don’t have a POLST form?

Without a POLST form, emergency medical personnel, nurses and doctors would not know your treatment wishes. You will most likely receive all possible treatments, whether you want them or not. Talking about your treatment choices with your loved ones and doctor before a problem occurs can guide them and help ensure you get the care you want.

Are faxed copies and/or photocopies valid? Must green paper be used?

Faxed copies and photocopies are valid. Bright green paper is used to distinguish the form from other forms in the patient’s record; however, the form will be honored on any color paper.

How can I get a POLST form?

Patients can request the form from their health care provider. It is important to discuss your goals of treatment with your health care provider so you can decide if POLST is right for you, and how to document your decisions appropriately on the form.

Patients may also obtain a form by sending a self-addressed, stamped envelope to WSMA, Attn: POLST, 2001 Sixth Avenue, Suite 2700, Seattle, WA 98121. Once you receive the form, contact your attending physician's office and make an appointment to discuss the form and your wishes regarding life-sustaining treatment.

Where is POLST used now?

POLST was originally developed in Oregon. There are a number of states that currently have POLST programs in place or that are developing POLST programs. For more information on the national POLST effort, visit www.polst.org.

What if I travel to another state—will my POLST be valid?

If you are traveling to another state, it is a good idea to take both your advance directive and your POLST form with you. Both documents, even if not legally binding, will help health care providers know your wishes.

What if I move to another state—will my POLST be valid?

If you are moving, you should bring your POLST with you to your first appointment with your new health care professional to put your wishes on that state’s POLST form (for a list of states with POLST programs, visit the national POLST program website at www.polst.org). You should also talk to your attorney about updating your advance directive, as some states require you use a specific form in order for your advance directive to be valid.