
September2019Previouslycompleteddocumentsarevaliduntilrevisedorrevoked.SENDORIGINALFORMWITHPERSONWHENEVERTRANSFERREDORDISCHARGED HIPAAPERMITSDISCLOSUREOFTHISINFORMATIONTOOTHERHEALTHCAREPROFESSIONALSASNECESSARY.
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How to fill out the MT Provider Orders For Life-Sustaining Treatment (POLST) online
This guide provides clear and supportive instructions for filling out the Montana Provider Orders For Life-Sustaining Treatment (POLST) online. Whether you are a healthcare provider or an individual filling out the form, this step-by-step approach will help you navigate each section effectively.
Follow the steps to complete the POLST form online.
- Press the ‘Get Form’ button to access the POLST document and open it in your editing tool.
- Begin by entering the legal last name, first name, and middle name of the person for whom the orders are being made, along with their date of birth.
- In Section A, select one checkbox only to designate the choice regarding cardiopulmonary resuscitation (CPR). Choose 'YES CPR' to attempt resuscitation or 'NO CPR' to indicate do not attempt resuscitation, which implies that full treatment is appropriate.
- In Section B, choose one option regarding medical interventions. Options include 'Full Treatment,' 'Selective Treatment,' or 'Comfort-focused Treatment.' Ensure to mark your choice clearly.
- Move to Section C regarding artificially administered nutrition. Select one option that describes the approach to nutrition: long term, short term, or no artificial nutrition.
- In Section D, indicate who has been discussed regarding these orders. Check all that apply, including the legal guardian, patient, or other individuals.
- Ensure signatures are collected in the mandatory fields. The patient or legal decision-maker should sign the document, along with the provider’s signature.
- Double-check all filled-out information for accuracy and clarity. Once everything is complete, you can save your changes, then download, print, or share the document as needed.
Complete your POLST form online today to ensure your treatment preferences are documented.
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