Get (polst) Form - Idph - Illinois.gov

The Practitioner Orders for Life-Sustaining Treatment (POLST) form is a vital document that allows individuals to define their preferences for medical treatment. This guide provides clear, step-by-step instructions for filling out the POLST form online, ensuring that users can accurately reflect their medical treatment wishes.

Follow the steps to complete the POLST form online successfully.

1. Press the ‘Get Form’ button to access the POLST form and open it in the editor.
2. Fill in the patient’s personal information, including first name, last name, date of birth, and address. This information is essential for identifying the individual for whom the orders are being made.
3. Select the desired medical intervention by choosing one of the options provided for resuscitation: ‘Attempt Resuscitation/CPR’ or ‘Do Not Attempt Resuscitation/DNR’. This section outlines the user's preferences for life-saving measures.
4. In the section for medical interventions, indicate the preferred level of treatment: ‘Full Treatment’, ‘Selective Treatment’, or ‘Comfort-Focused Treatment’. Each option highlights different goals and approaches to health care, so choose according to the individual’s wishes.
5. For medically administered nutrition, check the appropriate box, indicating whether long-term nutrition, trial periods, or no medically administered nutrition is desired.
6. Documentation of discussion section requires the signature of the patient or their legal representative. Ensure this section is completed by signing and printing the name, and include the date.
7. Have the authorized practitioner (physician, advanced practice nurse, or physician assistant) sign and print their name in the designated area to validate the form.
8. Before finalizing, ensure the witness has signed the form, if applicable, to confirm the discussions and consent have occurred.
9. Once all sections are filled, check the completed form for any necessary revisions before saving. Users can then save changes, download, print, or share the form as needed.

Complete your POLST form online to ensure your medical treatment preferences are recorded accurately.