Get the free The POLST Form - Northwest Regional Council - nwrcwa
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AGING & DISABILITY RESOURCES Northwest Regional Council 600 Lake way Drive, Suite 100 Bellingham, WA 98225 (360) 738-2500 www.nwrcwa.org Northwest Regional Council 1650 Port Drive Burlington, WA 98233
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How to fill out the polst form
How to fill out the POLST form:
01
Start by obtaining a copy of the POLST form from your healthcare provider or from your state's department of health.
02
Review the form carefully, paying special attention to the instructions and the various sections. Make sure you understand the purpose and implications of each section.
03
Begin by filling out your personal information, such as your name, date of birth, and contact details.
04
Move on to the section regarding your medical condition. Provide accurate and up-to-date information about your current health status, any chronic illnesses you may have, and any specific treatment preferences you may have discussed with your healthcare provider.
05
Consider the various treatment options available, such as CPR, intubation, and artificial nutrition. For each option, indicate your preference by checking the appropriate box - either for attempting the treatment or for withholding it. Be sure to communicate your wishes clearly and precisely.
06
If you have appointed a healthcare agent or designated a surrogate decision-maker, indicate their contact information in the appropriate section. This person will be responsible for making medical decisions on your behalf if you are unable to do so.
07
After completing all the necessary sections, review the form with your healthcare provider. They can clarify any doubts you may have and ensure that the form accurately reflects your wishes.
08
Finally, sign and date the form, and have it witnessed if required by your state's regulations.
Who needs the POLST form?
01
The POLST form is particularly important for individuals with serious and advanced illnesses.
02
It is intended for individuals who have made decisions about their end-of-life care, especially those who may want to limit certain life-sustaining treatments.
03
People of all ages who have chronic conditions or who are frail and at risk of medical emergencies can benefit from having a POLST form in place.
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What is the polst form?
The POLST form is a medical order form that indicates a patient's wishes regarding life-sustaining treatments.
Who is required to file the polst form?
The polst form is typically completed by patients who have advanced chronic illnesses or are nearing the end of life.
How to fill out the polst form?
The polst form must be completed with the assistance of a healthcare provider and signed by both the patient or their authorized representative.
What is the purpose of the polst form?
The purpose of the polst form is to ensure that a patient's end-of-life wishes are honored and followed by medical professionals.
What information must be reported on the polst form?
The polst form includes information on the patient's preferences for CPR, intubation, and other life-sustaining treatments.
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