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  • Download The Master Copy Polst Form For Print - Wsma

Get Download The Master Copy Polst Form For Print - Wsma

P HIPAA PERMITS DISCLOSURE OF POLST TO OTHER HEALTH CARE PROVIDERS AS NECESSARY Physician Orders for Life-Sustaining Treatment First follow these orders, then contact physician, nurse practitioner.

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How to fill out the Download The Master Copy POLST Form For Print - Wsma online

The Physician Orders for Life-Sustaining Treatment (POLST) form is an essential document that helps individuals direct their medical treatment based on personal preferences and health conditions. This guide provides clear instructions for completing the Download The Master Copy POLST Form For Print - Wsma online, ensuring that your wishes are accurately reflected.

Follow the steps to fill out the POLST form effectively.

  1. Click the ‘Get Form’ button to access the POLST form and open it in your text editor.
  2. Begin by filling in the patient's last name, first name, middle initial, last four digits of their Social Security Number, date of birth, and gender. Ensure accuracy as this information is crucial for identification.
  3. In the Medical Conditions/Patient Goals section, check the boxes that apply to the patient's current health condition and their care preferences, ensuring that all selections reflect the patient's wishes.
  4. For Cardiopulmonary Resuscitation (CPR) preferences, select either 'DNAR/Do Not Attempt Resuscitation' or 'CPR/Attempt Resuscitation'. Be sure to understand the implications of each choice.
  5. In the Medical Interventions section, choose one of the three options based on the desired level of care: 'Comfort Measures Only', 'Limited Additional Interventions', or 'Full Treatment'. Each option outlines specific medical treatments and hospital transfer preferences.
  6. Add any Additional Orders necessary, such as dialysis or other specific treatments, in the provided space.
  7. Collect the required signatures. The physician/ARNP/PA-C must sign and date the form. Ensure the patient's or legal surrogate's signature is also obtained for validity.
  8. Double-check all completed sections to confirm information is accurate and complete. Any incomplete sections imply full treatment preferences.
  9. Once finalized, save your changes, download the completed form, and print or share it as needed.

Ensure your preferences are documented accurately by completing the POLST form online today.

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Print BOTH pages as a double-sided form on a single sheet of paper. Health care providers should complete this form only after a conversation with their patient or the patient's representative.

Because the POLST form is a medical order, emergency medical personnel are required to follow its instructions regarding CPR and other emergency medical care. The POLST form is printed on bright pink paper so it will be easily recognizable by all health care personnel.

Physician Orders for Life-Sustaining Treatment (POLST) The POLST form is a medical order that gives seriously ill patients more control over their care by specifying the type of medical treatment a patient wishes to receive at the end of life.

MOLST and POLST are two acronyms defining medical orders. The MOLST is the Medical Orders for Life-Sustaining Treatment and the POLST is the Physician Orders for Life-Sustaining Treatment. They're both the same thing, but in different states they call them by those two different names.

POLST communicates your wishes as medical orders “Take me to the hospital” or “I want to stay here” “Yes, attempt CPR” or “No, don't attempt CPR” “These are the medical treatments I want” “This is the care plan I want followed”

These policies are often referred to by the acronym POLST (Physicians Orders for Life- Sustaining Treatment). When an advance directive exists, this set of orders should reflect wishes previously expressed by the patient, but an advance directive is not necessary for a physician to write medical orders.

A POLST form tells all health care providers during a medical emergency what you want: “Take me to the hospital” or “I want to stay here” “Yes, attempt CPR” or “No, don't attempt CPR” “These are the medical treatments I want”

Because the POLST form is a medical order, emergency medical personnel are required to follow its instructions regarding CPR and other emergency medical care. The POLST form is printed on bright pink paper so it will be easily recognizable by all health care personnel.

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Get Download The Master Copy POLST Form For Print - Wsma
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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Download The Master Copy POLST Form For Print - Wsma
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