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Get NJ POLST 2012-2024

T (POLST) Follow these orders, then contact physician/APN. This Medical Order Sheet is based on the current medical condition of the person referenced below and their wishes stated verbally or in a written advance directive. Any section not completed implies full treatment for that section. Everyone will be treated with dignity and respect. Person Name (last, first, middle) Date of Birth GOALS OF CARE (See reverse for instructions. This section does not constitute a medical order.) A MEDICAL.

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