Get the free California POLST Form – Summary of Changes - capolst

This document summarizes the changes made to the California POLST (Physician Orders for Life-Sustaining Treatment) form effective April 1, 2011, as recommended by the California POLST Task Force after

How to fill out california polst form summary

How to fill out California POLST Form – Summary of Changes

1. Obtain the California POLST form from a healthcare provider or download it from the official website.
2. Fill in the patient's name, date of birth, and medical record number at the top of the form.
3. Indicate the patient's goals of care in section A, choosing options that align with their desires.
4. In section B, select the appropriate medical interventions the patient prefers, considering their health status.
5. Review section C to determine the desired level of comfort care and additional life-sustaining treatments.
6. Ensure that the form is signed and dated by both the patient (or their surrogate) and the healthcare provider.
7. Distribute copies of the completed form to all relevant medical professionals and keep one for the patient's records.

Who needs California POLST Form – Summary of Changes?

1. The California POLST Form is intended for individuals with serious illnesses or frailty who wish to communicate their medical preferences.
2. It is typically used by patients nearing the end of life or those who desire clear directed care in emergencies.
3. Family members, caregivers, and healthcare providers involved in patient care should also be aware of the POLST form to ensure that the patient's wishes are honored.

People Also Ask about

How long is a POLST form valid?

Reviewing a POLST form: This form does not expire but should be reviewed whenever the patient: (1) is transferred from one care setting or level to another; (2) has a substantial change in health status; (3) changes primary provider; or (4) changes his/her treatment preferences or goals of care.

Does a POLST override an advance directive?

The POLST form complements an Advance Directive and is not intended to replace that document. An Advance Directive is still necessary to appoint a legal health care decisionmaker, and is recommended for all adults, regardless of their health status.

What makes a POLST form invalid?

First, as noted earlier, POLST forms that document inconsistent care preferences or lack a required signature are not enforceable.

How do I update a POLST?

Can I change my POLST form? You can void your POLST form but, since it is a medical order signed by a provider, you cannot edit it. If you want to change it, talk with your provider. If you want to void it, either draw a line across the form and write “VOID” in larger letters or destroy the form.

What is the difference between a POLST and a DNR order?

A POLST is more comprehensive than a “Do Not Resuscitate” order. A DNR is a stand-alone document that tells emergency medical personnel whether to perform CPR if your heart and breathing stop and you are unresponsive. A POLST includes your instructions about whether or not to perform CPR, but it doesn't stop there.

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.

What is the difference between a POLST and a DNR order?

A POLST is more comprehensive than a “Do Not Resuscitate” order. A DNR is a stand-alone document that tells emergency medical personnel whether to perform CPR if your heart and breathing stop and you are unresponsive. A POLST includes your instructions about whether or not to perform CPR, but it doesn't stop there.

What makes a POLST form invalid?

First, as noted earlier, POLST forms that document inconsistent care preferences or lack a required signature are not enforceable.

For pdfFiller’s FAQs

What is California POLST Form – Summary of Changes?

The California POLST Form – Summary of Changes is an update to the Physician Orders for Life-Sustaining Treatment (POLST) form that provides clear guidance for healthcare providers regarding the wishes of patients regarding end-of-life medical treatments.

Who is required to file California POLST Form – Summary of Changes?

Healthcare professionals who are responsible for providing medical care to patients with serious illnesses, as well as patients or their legal representatives, are required to file the California POLST Form – Summary of Changes.

How to fill out California POLST Form – Summary of Changes?

To fill out the California POLST Form – Summary of Changes, a patient or their legal representative should discuss their healthcare preferences with a physician, complete the form based on these preferences, and ensure it is signed by both the patient and the physician.

What is the purpose of California POLST Form – Summary of Changes?

The purpose of the California POLST Form – Summary of Changes is to ensure that patients' wishes regarding medical treatment at the end of life are respected and adhered to by healthcare providers, facilitating better communication and decision-making.

What information must be reported on California POLST Form – Summary of Changes?

The information that must be reported on the California POLST Form – Summary of Changes includes the patient's medical condition, treatment preferences regarding resuscitation, and specific instructions for medical treatments such as antibiotics and hospitalization.