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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.
- Click the ‘Get Form’ button to access the POLST form and open it in your text editor.
- 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.
- 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.
- 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.
- 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.
- Add any Additional Orders necessary, such as dialysis or other specific treatments, in the provided space.
- 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.
- Double-check all completed sections to confirm information is accurate and complete. Any incomplete sections imply full treatment preferences.
- 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.
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