Get Polst Form

The Provider Orders for Life-Sustaining Treatment (POLST) Form allows individuals to communicate their medical treatment preferences in a clear and legally recognized manner. This guide will walk you through the steps to fill out the POLST Form online, ensuring that your choices are accurately documented according to your current medical condition and preferences.

Follow the steps to complete the POLST Form online

1. Press the ‘Get Form’ button to access and open the POLST Form in your chosen editor.
2. Fill out the personal information section, including the last name, first name, middle initial, date of birth, primary medical care provider's name, and their phone number.
3. In section A, indicate your preferences for cardiopulmonary resuscitation (CPR) by checking one of the options provided: Attempt Resuscitation or Do Not Attempt Resuscitation.
4. Proceed to section B and check one of the medical treatments options that best reflects your wishes when the patient is breathing or has a pulse. Choices include Full Treatment, Selective Treatment, or Comfort-Focused Treatment.
5. In section C, check all applicable documentation options that reflect the discussion regarding your treatment wishes. This may include options for healthcare agents or other surrogates.
6. Sign in the designated area to acknowledge that the orders reflect your treatment wishes. If you are a surrogate, print your name and indicate your relationship to the patient.
7. Finalize the form by having a physician, APRN, or PA sign in section D to confirm that the orders are consistent with the patient’s condition and preferences.
8. Complete section E by adding any additional patient preferences, if desired, and provide contact information for the healthcare provider who prepared the document.
9. After reviewing the completed POLST form for accuracy, save your changes, or download, print, or share the form as required.

Complete your POLST Form online today to ensure your medical treatment preferences are known.