Get Provider Order For Life-sustaining Treatment (polst) Utah Life With Dignity Order Bureau Of Health

Completing the Provider Order For Life-Sustaining Treatment (POLST) is essential for ensuring that health care wishes are respected. This guide provides clear, step-by-step instructions for filling out the POLST form online, helping you navigate each section with ease.

Follow the steps to complete the POLST form effectively.

1. Use the ‘Get Form’ button to retrieve the POLST form and open it in your preferred editor.
2. Begin filling out the patient information section, which includes the patient's last name, first name, middle initial, date of birth, and the last four digits of their Social Security number.
3. Enter the patient's address, including street, city, state, and zip code, followed by the effective date of this order.
4. Complete the medical provider's section by entering their name, phone number, and providing a brief description of the patient's medical condition.
5. In Section A, indicate the treatment options for cardiopulmonary resuscitation (CPR). Choose one option: attempt to resuscitate, do not attempt, or express no preference.
6. Move to Section B and select the medical interventions, specifying one option: full treatment, limited additional interventions, comfort measures, or no preference.
7. In Section C, specify options regarding artificial nutrition, choosing trial periods, long-term options, or indicating no preference.
8. If applicable, identify the health care agent named in the advance directive. If none is available, state so and include their phone number.
9. Read and sign the section on patient preferences regarding the order, and select whether it should serve as a general guide or be strictly followed.
10. Collect the necessary signatures, including that of the medical provider. Ensure to meet signature requirements for minors as needed.
11. Include any additional instructions or clarifications in the designated section, particularly regarding goals or time periods for any desired interventions.
12. Review the completed form carefully for accuracy, then proceed to save changes, download, print, or share the form as needed.

Complete the POLST form online today to ensure your health care preferences are respected.