Get CA EMSA 111 B 2011
First follow these orders, then contact physician. This is a Physician Order Sheet based on the person’s current medical condition and wishes. Any section not completed implies full treatment for that section. A copy of the signed POLST form is legal and valid. POLST complements an Advance Directive and is not intended to replace that document. Everyone shall be treated with dignity and respect. Patient Last Name: Date Form Prepared: Patient First Name: Patient Date of Birth: Patient Midd.
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