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  • Ca Emsa 111 B 2009

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B (Effective 1/1/2009) A Check One Last Name 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. Everyone shall be treated with dignity and respect. First /Middle Name Date of Birth CARDIOPULMONARY RESUSCITATION (CPR): Attempt Resuscitation/CPR Date Form Prepared Person has no pulse and is not breathing. Do Not Attempt Resuscitat.

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Like a DNR, a POLST form lets EMS know whether or not the patient wants CPR. DNR orders only apply when a person does not have a pulse, is not breathing and is unresponsive. However, in most medical emergencies, a person does have a pulse, is breathing or is responsive. That's where POLST is different.

POLST must be completed by a health care provider based on patient preferences and medical indications.

Physician Orders for Life Sustaining Treatment (POLST) is a medical order that helps give people with serious illness more control over their care during a medical emergency. POLST can help make sure you get the care you want, and also protect you from getting medical treatments you DO NOT want. POLST is voluntary.

Provider Orders for Life-sustaining Treatment (POLST) are portable medical orders that communicate to health care facilities and providers a patient's wishes for end-of-life intervention, including emergency medical services (EMS).

MOLST and POLST are two acronyms defining medical orders. The MOLST is the Medical Orders for Life-Sustaining Treatment and the POLST is the Physician Orders for Life-Sustaining Treatment. They're both the same thing, but in different states they call them by those two different names.

Just as with DNR orders, family members generally cannot override a patient- and physician-signed POLST order. ingly, all efforts should be made to get patients, families, and providers on the same page before an acute event, to prevent confusion about the plan of care and distress for families and providers.

Physician Orders for Life-Sustaining Treatment (POLST) The EMSA approved POLST form must be signed and dated by a physician, or a nurse practitioner or a physician assistant acting under the supervision of the physician, and the patient or legally recognized health care decisionmaker.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232