POLST – Physician Orders for
Life-Sustaining Treatment
For Patients and Families
POLST (Physician Orders for Life-Sustaining Treatment) is a form that states what kind of medical treatment patients want toward the end of their lives. Printed on bright pink paper, and signed by both a doctor and patient, POLST helps give seriously ill patients more control over their end-of-life care.
- POLST Form
- Resources for Health Care Professionals
- POLST Consumer Brochure
- POLST Frequently Asked Questions
- POLST Community Coalitions throughout California
The California POLST Project is lead by the Coalition for Compassionate Care of California and is supported through a grant from the California HealthCare Foundation.
POLST Forms
- POLST form English [PDF]
- POLST form Spanish [PDF]
- POLST form Chinese [PDF]
POLST forms and Pulsar Pink paper may be purchased in bulk from Med-Pass.
Resources for Consumers
- POLST Consumer Brochure [PDF]
POLST Frequently Asked Questions
- Download FAQs [PDF]
- What does ‘POLST’ stand for?
- What is the POLST form?
- What information is included on the POLST form?
- Is POLST required by law?
- Who should have 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 pink paper be used?
- How can I get a POLST form?
- Where do they use POLST now?
- When was POLST authorized in California?
- What if I travel to another state – will my POLST form be valid?
- How can I find out more about POLST?
- What does ‘POLST’ stand for?
-
POLST stands for Physician Orders for Life-Sustaining Treatment.
- What is the POLST form?
-
POLST is a physician order that helps give seriously ill patients more control over their end-oflife care. Produced on a distinctive bright pink form and signed by both the doctor and patient, POLST specifies the types of medical treatment that a patient wishes to receive towards 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 information is included on the POLST form?
-
The decisions documented on the POLST form include whether to:
- Attempt cardiopulmonary resuscitation,
- Administer antibiotics and IV fluids,
- Use a ventilator to help with breathing, and
- Provide artificial nutrition by tube.
- Is POLST required by law?
-
Filling out a POLST form is entirely voluntary, but California law requires that the physician orders in a POLST be followed by health care providers.
- Who should have a POLST form?
-
POLST is designed for seriously ill individuals, or those who are in very poor health, regardless of their age.
- Does the POLST form replace traditional Advance Directives?
-
The POLST form complements an Advance Directive and is not intended to replace that document. An Advance Directive is still necessary to appoint a legal health care decisionmaker, 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, or social worker, completes the form after having a conversation with the patient to understand his/her wishes and goals of care. Both a doctor and the patient must sign the POLST form in order for it to be valid.
- 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 decisionmaker can then sign the POLST form on behalf of their loved one.
- What happens to my POLST form after it is completed and signed?
-
The original POLST form, on bright pink 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 form at any time should your preferences 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 pink paper be used?
-
Faxed copies and photocopies are valid. Pulsar pink 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. The form can also be found at caPOLST.org, along with other helpful resources.
- Where do they use POLST now?
-
POLST was originally developed in Oregon. There are a number of states which currently have POLST programs in place or that are developing POLST programs. For more information on the national POLST effort, visit polst.org.
- When was POLST authorized in California?
-
California State POLST Legislation (AB 3000 (Statutes 2008, Chapter 266)) went into effect on January 1, 2009.
- What if I travel to another state – will my POLST form be valid?
-
The California POLST form is valid in California. 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.
- How can I find out more about POLST?
-
Talk to your doctor, or visit the California POLST website at capolst.org
Download FAQs [PDF]
POLST Community Coalitions throughout California
CCCC, lead agency for POLST in California, is coordinating 18 community POLST coalitions. The California HealthCare Foundation (CHCF) is funding these coalitions to promote establishment of POLST in local communities around California.
List of coalitions/contacts
- Local POLST Community Coalitions [PDF]
- POLST in California Communities: First-Year Experience and Lessons Learned [PDF]
- Building POLST Coalitions [PDF]
Tips to build a successful coalition.
For more information, please contact Erin Henke, POLST Program Manager, at (916) 552-7688 or ehenke@finalchoices.org
Videos
Related videos, click on the video thumbnail below to watch.
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POLST at Work in California
This 12-minute video provides a detailed look at the POLST form and how it works in a community as a patient is transferred between health care settings. The video is designed for health care professionals, but can also be helpful for consumers wishing to learn more about POLST. The video is adapted from Oregon’s POLST at Work video.
POLST: Honoring Patient Wishes for Treatment
This 47-minute educational program was featured on UCTV as part of the UC Davis Health System/Center for Healthy Aging Coming of Age Lecture Series, and is now available on YouTube. The video includes a question and answer session about POLST, the POLST at Work in California video, and a demonstration of a POLST conversation between a physician and patient.
Honoring the Wishes of the Spanish
Speaking Patient and Family
English version | Spanish versionThis 19-minute video from Oregon’s POLST program is designed for the Spanish-speaking community and addresses the important role of bilingual family members and the use of an interpreter, as well as how culture and spirituality can play an important role during end-of-life care. Designed for health care professionals, patients and family members.
