About this form
The Alabama Physician Orders for Life Sustaining Treatment (POLST) form is a medical document that captures a patientâs healthcare preferences regarding end-of-life treatments. It serves to communicate a patientâs desires for cardiopulmonary resuscitation (CPR), intubation, hospitalization, and artificial nutrition and hydration. Unlike an advance directive, this form is a medical order meant for immediate use by healthcare providers and does not expire.
Form components explained
- Patient Information: Includes basic details about the patient, such as name, date of birth, and social security number.
- Cardiopulmonary Resuscitation Orders: Specifies whether or not to attempt CPR if the patient has no pulse and is not breathing.
- Treatment Orders: Outlines the type of medical treatment to be provided if the patient has a pulse and/or is breathing.
- Medically Assisted Nutrition: Details preferences regarding artificial nutrition and hydration.
- Signatures: Requires signatures from both the patient or their representative and the healthcare provider, validating the form.
Common use cases
This form should be used when a patient wishes to document their preferences for medical treatment during a critical health situation. It is especially relevant for patients with serious, life-limiting conditions who are at risk of a life-threatening event, ensuring that their care aligns with their wishes during emergencies.
Who can use this document
- Patients with life-limiting medical conditions seeking to clarify their end-of-life care preferences.
- Representatives of patients who are unable to make decisions regarding their healthcare.
- Healthcare providers responsible for discussing and implementing treatment plans with patients.
How to complete this form
- Fill in patient information, including full name, date of birth, and preferred name.
- Choose preferences regarding cardiopulmonary resuscitation (CPR) and treatment orders based on patient discussions.
- Document any additional orders or instructions identified in the patient conversation.
- Sign the form as the patient or their representative, confirming that the decisions made align with the patientâs wishes.
- Have the healthcare provider sign the form, ensuring all orders reflect the patient's desires.
Does this form need to be notarized?
This form does not typically require notarization unless specified by local law. However, it is important that all signatures are collected properly and that the form is executed in accordance with state regulations to ensure its validity.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Avoid these common issues
- Not discussing the form with a healthcare provider before completion.
- Leaving sections of the form incomplete, which may create ambiguity regarding patient preferences.
- Failing to update the form after significant changes in the patientâs health status or care preferences.
Why complete this form online
- Convenience of accessing and downloading the form at any time.
- Editability allows users to fill out the form accurately before printing.
- Reliable templates drafted by licensed attorneys ensure compliance with legal standards.
Legal use & context
- This form serves as a valid medical order recognized in Alabama and does not require notarization.
- Healthcare providers are legally obligated to follow the directives outlined in the POLST form.
- The POLST form is designed for immediate implementation, distinguishing it from general advance directives.
Quick recap
- The POLST form clearly communicates a patient's healthcare preferences in emergency situations.
- It is crucial for patients with serious medical conditions to have this form in place.
- Completing the POLST form requires careful discussion between the patient and healthcare provider.