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Get IL IDPH Uniform Practitioner Orders For Life-Sustaining Treatment (POLST) Form 2015-2024

Of Birth (mm/dd/yy) ences. Any section not completed does not invalidate the form and implies initiating all treatment for that section. With significant change of condition new orders may Address (street/city/state/ZIPcode) need to be written. A Check One B When not in cardiopulmonary arrest, follow orders B and C. MEDICAL INTERVENTIONS If patient is found with a pulse and/or is breathing. q Full Treatment: Primary goal of sustaining life by medically indicated means. In addition to t.

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