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The POLST form specifies the types of medical treatment that a patient wishes to receive towards the end of life and is a part of a program for end of life decisions.
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How to fill out polst form
How to fill out POLST Form
01
Obtain a POLST Form from a healthcare provider or online.
02
Fill out the patient's personal information, including name and date of birth.
03
Discuss medical preferences with the patient or their healthcare proxy.
04
Indicate preferences for resuscitation, including do not resuscitate (DNR) if applicable.
05
Specify treatment preferences such as hospitalization, comfort measures, and interventions.
06
Review the completed form with the patient to ensure accuracy and understanding.
07
Sign and date the form by both the patient and the healthcare provider.
08
Distribute copies to the patient's medical records, emergency contacts, and keep a copy at home.
Who needs POLST Form?
01
Patients with serious or terminal illnesses.
02
Individuals with advanced age or multiple health issues.
03
Patients transitioning from hospital to home or hospice care.
04
Anyone who wishes to make their healthcare preferences known in advance.
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What does a POLST form include?
POLST communicates your wishes as medical orders A POLST form tells all health care providers during a medical emergency what you want: “Take me to the hospital” or “I want to stay here” “Yes, attempt CPR” or “No, don't attempt CPR”
Where can I obtain a POLST form?
How to Order the National POLST Form. Visit your program website or reach out to your program contact to order POLST forms. Forms are not available to individuals since they are medical orders that should be completed by providers.
Can I download a POLST form?
National POLST Model Form A copy of this publication may be downloaded, stored, or printed for personal use only; all other uses require written permission.
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What is POLST Form?
The POLST (Physician Orders for Life-Sustaining Treatment) Form is a medical document that outlines a patient's preferences for end-of-life care and treatment. It serves as a tool for patients and healthcare providers to communicate and ensure that the patient's wishes are respected.
Who is required to file POLST Form?
The POLST Form is typically completed by patients who have serious, life-limiting illnesses or are at risk of dying within the near future. It is usually filled out in collaboration with healthcare providers, such as physicians or nurse practitioners.
How to fill out POLST Form?
To fill out the POLST Form, patients or their authorized decision-makers should consult with healthcare providers to discuss treatment preferences. The form includes sections for medical orders regarding resuscitation status, medical interventions, and other preferences which should be clearly articulated and documented.
What is the purpose of POLST Form?
The purpose of the POLST Form is to ensure that a patient's wishes regarding medical treatment at the end of life are understood and honored by healthcare professionals, particularly in emergency situations.
What information must be reported on POLST Form?
The POLST Form includes information such as the patient's medical condition, preferences for resuscitation (CPR), use of antibiotics, medical interventions, and any specific wishes regarding treatment and care at the end of life.
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