Last updated on
Aug 6, 2026
WA Physician Orders for Life-Sustaining Treatment (POLST) 2017 free printable template
pdfFiller is not affiliated with any government organization
Fill out
Complete the form online in a simple drag-and-drop editor.
eSign
Add your legally binding signature or send the form for signing.
Share
Share the form via a link, letting anyone fill it out from any device.
Export
Download, print, email, or move the form to your cloud storage.
Why pdfFiller is the best tool for your documents and forms
End-to-end document management
From editing and signing to collaboration and tracking, pdfFiller has everything you need to get your documents done quickly and efficiently.
Accessible from anywhere
pdfFiller is fully cloud-based. This means you can edit, sign, and share documents from anywhere using your computer, smartphone, or tablet.
Secure and compliant
pdfFiller lets you securely manage documents following global laws like ESIGN, CCPA, and GDPR. It's also HIPAA and SOC 2 compliant.
What is WA Physician Orders for Life-Sustaining Treatment (POLST)
The POLST Form is a medical consent document used by patients and healthcare providers in Washington to guide treatment decisions based on patient preferences regarding life-sustaining treatment.
pdfFiller scores top ratings on review platforms
Found it a little difficult to place text exactly where it needed to be placed.
PDFfiller is very user friendly and saved my forms even when my subscription lapsed saving me a lot of time.
Who needs WA Physician Orders for Life-Sustaining Treatment (POLST)?
Explore how professionals across industries use pdfFiller.
WA Physician Orders for Life-Sustaining Treatment (POLST) is needed by:
-
Patients or legal surrogates seeking to express end-of-life care preferences
-
Healthcare providers and medical staff responsible for patient care
-
Physicians, ARNPs, or PA-Cs who need to document treatment orders
-
Hospitals and medical facilities handling patient transfers or discharges
-
Legal advisors assisting with advance care planning
Comprehensive Guide to WA Physician Orders for Life-Sustaining Treatment (POLST)
What is the POLST Form?
The POLST (Physician Orders for Life-Sustaining Treatment) form is a crucial healthcare directive that provides clear medical orders regarding patient treatment preferences. This form guides healthcare providers in making decisions that align with the patient's wishes, primarily focusing on life-sustaining treatment options. Its significance is particularly pronounced in end-of-life care and advance care planning, ensuring that individual preferences are respected and communicated effectively among healthcare providers.
Purpose and Benefits of the POLST Form
The POLST form serves as an essential tool for patients, families, and healthcare providers. It guarantees that patient preferences regarding medical treatments are honored during critical healthcare decisions. By having a medical consent form that clearly outlines these preferences, the POLST form helps to streamline care processes and minimize unnecessary interventions, ultimately improving the quality of end-of-life care. This clarity in medical orders aids in preventing misunderstandings and discrepancies in treatment approaches.
Key Features of the POLST Form
The POLST form is structured into several key sections, each designed to capture specific medical orders and preferences. Some of the main sections include:
-
CPR preferences
-
Medical interventions
-
Non-emergency treatment choices
Each section is significant as it influences the type of care a patient receives. When filling out the form, it’s necessary to provide accurate information, potentially discussing it with a healthcare provider to ensure that all details align with the patient's health goals.
Who Needs the POLST Form?
The POLST form is vital for adults, particularly those facing chronic illnesses or advanced age. It must be completed by the patient or their legal surrogate, ensuring that the individual’s healthcare preferences are accurately reflected. Certain circumstances make having a POLST form crucial, including severe or terminal conditions, where advanced planning regarding treatment is essential. Eligibility criteria include being of sound mind to understand the implications of the decisions made.
How to Fill Out the POLST Form Online
Completing the POLST form online is a straightforward process through pdfFiller’s platform. Here is a step-by-step guide:
-
Access the POLST form on pdfFiller.
-
Fill in personal details, including name and date of birth.
-
Choose your CPR preferences and treatment wishes.
-
Review the information for accuracy.
-
Submit the completed form for review.
Ensuring accuracy and completeness is vital, so take the time to verify all entries before submitting.
Signing and Notarizing the POLST Form
The POLST form requires signatures from authorized individuals, including a physician, ARNP, or PA-C, alongside the patient or legal surrogate. Digital signatures are permissible; however, understanding the differences between digital and wet signatures is essential. If notarization is needed, follow the outlined process to ensure the form’s validity under state laws.
Where to Submit the POLST Form
Once the POLST form is completed, it should be submitted to the appropriate healthcare provider or facility. The submission methods may vary, including electronic submission or physical delivery to a medical office. After submission, tracking the form is advisable to confirm its receipt and validity. Be aware of any deadlines regarding processing times for ensuring the form remains valid in critical situations.
Security and Compliance for the POLST Form
When using pdfFiller's platform, robust security measures are in place to protect sensitive documents. Compliance with regulations like HIPAA and GDPR is strictly maintained, ensuring that the privacy and data protection of medical consent forms are prioritized. Such measures are pivotal in safeguarding personal health information throughout the document management process.
Sample or Example of a Completed POLST Form
To assist users in understanding proper completion, a visual example of a filled POLST form can be beneficial. Common entries include choices regarding CPR and other medical interventions. Each entry provides insight into patient preferences, illustrating how they align with healthcare provider orders and medical decisions made during treatment.
Get Started with pdfFiller for Your POLST Form
Using pdfFiller to create and manage your POLST form is an efficient and secure option. The platform's ease of use, alongside features for eSigning and sharing, empowers users to maintain control over their healthcare forms. Utilize pdfFiller to ensure your POLST form is completed accurately and in compliance with necessary requirements.
How to fill out the WA Physician Orders for Life-Sustaining Treatment (POLST)
-
1.To begin, access pdfFiller and search for the POLST Form template in the document library.
-
2.Open the form by clicking on the template link for viewing and editing.
-
3.Before completing the form, gather necessary information, including patient medical history and wishes regarding life-sustaining treatments.
-
4.Navigate through the form on pdfFiller, filling in required fields such as patient details and treatment preferences using the available input tools.
-
5.Use checkboxes for specific treatment preferences and fill in blank fields with required information relevant to the patient’s care.
-
6.Ensure that both the patient or legal surrogate and the physician, ARNP, or PA-C sign the form digitally using pdfFiller's signature options.
-
7.Once all fields are completed and signatures are obtained, carefully review the entire form to confirm accuracy and completeness.
-
8.To finalize the form, save it within pdfFiller or download a copy to your device in the desired format for your records.
-
9.You may also directly submit the completed POLST Form to healthcare facilities or keep it for future reference using the sharing options provided by pdfFiller.
Who is eligible to sign the POLST Form?
The POLST Form must be signed by a physician, ARNP, or PA-C, along with the patient or their legal surrogate. Ensure that all signatories understand the patient's treatment preferences.
What are the common mistakes to avoid when completing this form?
Common mistakes include leaving blank fields, failing to obtain required signatures, and misunderstanding the treatment options. Double-check everything before submission to ensure it reflects the patient's wishes accurately.
Are there any deadlines for submitting the POLST Form?
While there are no strict deadlines, it is advised to complete and submit the POLST Form before any scheduled medical procedures or hospital transfers to ensure preferences are honored.
How should I submit the completed POLST Form?
The completed POLST Form can be printed and presented to healthcare facilities or saved digitally for electronic health records. Ensure the form is accessible to medical personnel during care.
What supporting documents may be required alongside the POLST Form?
No specific supporting documents are required, but having the patient's medical history and any previous advance directives can be beneficial for discussion with healthcare providers.
What happens if a POLST Form is not completed?
If a POLST Form is not completed, healthcare providers will default to standard emergency protocols, which may not align with the patient’s wishes regarding treatment. It's important to have this document to avoid unwanted interventions.
How often should the POLST Form be reviewed or updated?
The POLST Form should be reviewed periodically, especially after significant health changes or upon hospital transfers, to ensure it reflects the most current patient preferences and medical conditions.
WA Physician Orders for Life-Sustaining Treatment (POLST) Form Versions
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.