What Is a POLST Form—and How Do You Get One Signed?
When someone is living with a serious illness or advanced frailty, a medical emergency can force families to make difficult decisions very quickly. A Portable Orders for Life-Sustaining Treatment form, commonly called a POLST, can help ensure that the person’s treatment preferences are clearly understood.
What is a POLST?
A POLST is a portable medical order that tells healthcare professionals what treatments a seriously ill or medically frail person wants—or does not want—during a medical emergency.
Depending on the choices made, the form may include directions about:
- Cardiopulmonary resuscitation, or CPR
- Hospital transfer
- Intensive care
- Breathing support or mechanical ventilation
- Medications, IV fluids and other medical interventions
- Comfort-focused treatment
- Artificial nutrition
Because a completed POLST is a medical order, emergency responders and healthcare professionals can use it when the person cannot communicate their wishes.
Who should have a POLST?
A POLST is not intended for every adult. It is generally appropriate for someone who has a serious or progressive illness, advanced frailty, or very poor health and is at risk of experiencing a life-threatening medical emergency.
A healthy adult would usually begin with an advance directive and a durable power of attorney for healthcare. A POLST may become appropriate later if that person develops serious illness or advanced frailty.
Completing a POLST is voluntary. A hospital, nursing facility, assisted-living community or other provider should not force someone to complete one.
Is a POLST the same as an advance directive?
No. The two documents serve different purposes and often work together.
An advance directive describes broader healthcare wishes and allows a person to appoint someone to make medical decisions if they lose decision-making capacity. A POLST translates current treatment choices into specific medical orders that can be followed during an emergency.
A POLST does not replace the need for an advance directive or healthcare power of attorney.
How do you get a POLST signed?
1. Ask for a goals-of-care appointment
Contact the person’s primary-care physician, specialist, palliative-care clinician, hospice provider or facility-based medical professional. Ask for an appointment specifically to discuss goals of care and whether a POLST is appropriate.
In Washington, a POLST can be completed and signed by a physician—MD or DO—an advanced registered nurse practitioner, or a certified physician assistant.
2. Prepare for the conversation
Bring information that will help the clinician understand the person’s wishes, including:
- The current advance directive
- Durable power of attorney for healthcare documents
- Relevant medical history
- Questions about CPR, hospitalization, ventilation and comfort care
- The name of the legal healthcare decision-maker
- Any existing POLST form
The conversation should address the person’s diagnosis, likely course of illness, treatment options, personal values and goals. The purpose is not simply to obtain a signature; it is to make informed decisions based on the person’s current health.
3. Complete the form with the clinician
The healthcare professional should review each section and document the agreed-upon medical orders. The form should not be filled out alone and simply dropped off for a signature.
Washington requires signatures from both:
- The patient or the patient’s legally authorized medical decision-maker
- The signing physician, ARNP or PA-C
Without the required signatures, the form may not function as an actionable medical order.
4. Keep the completed form accessible
In Washington, the original form is commonly printed on bright green paper so emergency personnel can find it quickly, although copies, digital images, faxes and forms printed on other colors are valid.
Keep the POLST in an easy-to-find location, such as on the refrigerator or near the person’s bed—not locked in a safe or hidden in a filing cabinet. Provide copies to the primary-care provider, healthcare decision-maker, caregivers, assisted-living community, adult family home, nursing facility, hospice or other members of the care team.
The form should travel with the person when they move between home, a hospital, rehabilitation, long-term care or another healthcare setting.
Can a POLST be changed?
Yes. A person can request that the POLST be reviewed or changed when:
- Their health condition changes
- They move to a different care setting
- Their treatment preferences change
- The current form no longer reflects their goals
Ask the treating clinician to review the form and complete new orders when necessary. Make sure outdated copies are removed from the home, medical record and care setting so there is no confusion during an emergency.
Where can Washington residents obtain the form?
Patients can ask their physician or healthcare professional for the current Washington POLST. The form and patient guidance are also available through the Washington State Medical Association’s POLST Program.
A POLST is most effective when it results from an honest conversation among the patient, family or legal decision-maker, and healthcare professional. Taking time to discuss these choices before an emergency can give everyone clearer direction when it matters most.
This article provides general educational information and is not a substitute for individualized medical or legal advice. Requirements vary by state; people outside Washington should obtain the approved form and guidance for their state.