Get the free POLST Form POLST - ccah-alliance

POST Submission Fax Cover Sheet To: Central California Alliance for Health 1-877-793-8504 From: Practice/Provider Name REQUIRED Practice NPI#: REQUIRED Member Alliance ID#: REQUIRED Instructions:

How to fill out polst form polst

How to fill out a POLST form:

1. Start by obtaining the form: You can ask your healthcare provider or local hospital for a POLST form. It is important to have a current and updated form.
2. Provide personal information: Fill out your full name, date of birth, and contact information. This ensures that the form is correctly identified and associated with you.
3. Discussion with healthcare provider: Have a conversation with your healthcare provider to discuss your medical condition, treatment options, and goals of care. This is an essential step in understanding the different interventions and medical decisions you may face in the future.
4. Choose your treatment preferences: The POLST form provides different options for treatments and interventions. Decide which ones align with your wishes in the event of a medical emergency or end-of-life situation. These may include choices like CPR, intubation, artificial nutrition, antibiotics, and comfort measures.
5. Consult family and loved ones: Discuss your preferences with your family and loved ones to ensure they are aware of your choices. Having open and honest conversations about potential scenarios can help establish a shared understanding and reduce confusion in times of crisis.
6. Sign the form: Once you have carefully considered your treatment preferences, sign the form to indicate your consent and authorization. In some cases, a witness or healthcare provider may need to sign as well.

Who needs a POLST form:

1. Seriously ill patients: Individuals with serious or chronic illnesses, especially those in advanced stages, can benefit from having a POLST form. This ensures that healthcare professionals are aware of their treatment preferences and can provide care accordingly.
2. Elderly individuals: As people age, they may face more complex health issues and may require medical interventions. Having a POLST form helps guide healthcare professionals in delivering appropriate care based on the person's wishes.
3. Individuals with specific treatment preferences: Some people have personal or religious beliefs that may affect their medical decisions. A POLST form allows them to express their treatment preferences and ensure that these choices are respected and followed.

In summary, filling out a POLST form involves obtaining the form, providing personal information, discussing treatment preferences with a healthcare provider, consulting loved ones, and signing the form. This form is beneficial for seriously ill individuals, the elderly, and those with specific treatment preferences.

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What is polst form polst?

POLST stands for Physician Orders for Life-Sustaining Treatment. It is a medical form that outlines a patient's wishes for end-of-life care.

Who is required to file polst form polst?

POLST forms are typically completed by individuals with serious illnesses or frailty, in consultation with their healthcare providers.

How to fill out polst form polst?

POLST forms are typically completed by a healthcare provider in consultation with the patient or their authorized representative.

What is the purpose of polst form polst?

The purpose of the POLST form is to ensure that a patient's wishes for end-of-life care are honored by healthcare providers.

What information must be reported on polst form polst?

Information on the POLST form may include the patient's preferences regarding life-sustaining treatments such as resuscitation, intubation, and feeding tubes.