What is a POLST form?

Posted on Posted in Uncategorized


POLST, what is that you say…

POLST stands for, Physician Orders for Life-Sustaining Treatment.

It is a document that has been created by medical professionals to provide information to emergency responders. This is much like a health care proxy, but it is completed by a health care professional, with the input of the patient, patients family, durable power of attorney, and/or conservator. Whom ever it is that has the ability to answer the vital questions to tailor it to the person it is being prepared for are the ones that provide input.

If you don’t have a health care proxy or designated DPOA, the POLST will act as your voice. Usually it is completed by your Primary Care Physician, or a PA, or if you should end up in a hospital they will ask you if you want to fill one out there. It is recognized throughout the entire state of California.

This document is printed on a bright Pink, thick stock paper, almost like card stock. Seniors usually put them on the inside of their front or back doors where and first responder can find it, when they respond to a 911 call in emergency situations.

Here they talk about CPR, Cardiopulmonary Resuscitation, Medical Interventions (when there is a pulse or is breathing) or Artificially Administered Nutrition (feeding tube) stating what you want done in each area.

It clearly states that the information was discussed with the patient and or legal decision-maker. Both the doctor and the patient/legal representative sign it. Copies are usually placed in your permanent chart at the doctor office, and you take one home. The patients name, DOB, and the Health Care Provider who assists with the form are also printed on the reverse with additional contact information.

There is a push for all seniors to have not only a health care proxy but also a POLST.

For more information, please don’t hesitate to email me.

– askjaynie.com

Leave a Reply

Your email address will not be published. Required fields are marked *