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WyoPOLST Providers Orders for Life Sustaining Treatment HIPAA PERMITS DISCLOSURE TO HEALTHCARE PROFESSIONALS AS NECESSARY FOR TREATMENT Last Name/First Name:DO NOT PRINT THIS FORM. This form must
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How to fill out authorization for life-sustaining treatment

01
To fill out authorization for life-sustaining treatment, follow these steps:
02
Begin by downloading the necessary form from your healthcare provider or legal resource.
03
Read through the form carefully to understand the instructions and requirements.
04
Provide your personal information, including your name, date of birth, and contact details.
05
Consult with your healthcare provider or an attorney if you have any questions or need guidance.
06
Consider your medical wishes and preferences for life-sustaining treatment and clearly outline them in the form.
07
If you have any specific instructions or limitations, make sure to include them as well.
08
Review the completed form to ensure all information is accurate and complete.
09
Sign and date the form in the presence of a witness or notary public, if required.
10
Make copies of the completed form for your records and distribute them to relevant parties, such as your healthcare provider and family members.
11
Keep the original form in a safe and easily accessible place.
12
Remember to periodically review and update the authorization for life-sustaining treatment as your medical wishes or circumstances may change.

Who needs authorization for life-sustaining treatment?

01
Authorization for life-sustaining treatment is needed by individuals who want to ensure that their medical wishes for life-sustaining interventions are respected and followed even if they become incapacitated and unable to communicate their preferences.
02
This includes individuals who have specific preferences regarding resuscitation, mechanical ventilation, artificial nutrition, and hydration, as well as those who wish to designate a healthcare proxy or durable power of attorney for healthcare decisions.
03
It is especially important for individuals with chronic illnesses, terminal conditions, advanced age, or those who simply want to have a say in their end-of-life care.
04
By completing the authorization for life-sustaining treatment, individuals can have peace of mind knowing that their healthcare decisions will be honored.
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Authorization for life-sustaining treatment is a legal document that allows individuals to specify their preferences regarding medical treatment in situations where they are unable to communicate due to severe illness or injury.
Typically, individuals who wish to ensure their healthcare wishes are respected in critical situations, such as those with serious medical conditions or advanced age, are encouraged to file an authorization for life-sustaining treatment.
To fill out the authorization for life-sustaining treatment, individuals should obtain the appropriate forms, carefully read the instructions, specify their treatment preferences, and sign the document in the presence of a witness or notary if required.
The purpose of the authorization for life-sustaining treatment is to ensure that an individual’s wishes regarding medical care, especially in critical or life-threatening situations, are clearly understood and respected by healthcare providers.
The information that must be reported includes the individual's name, health status, specific medical treatments they do or do not want, and signatures of the individual and witnesses, if applicable.
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