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Physician Orders for Life-Sustaining Treatment

What is POLST?

POLST (Physician Orders for Life-Sustaining Treatment) is a form printed on bright pink paper that makes a person’s wishes for end-of-life care known to doctors, nurses, emergency medical personnel and other healthcare staff.

Who should have a POLST form?

The POLST form is important for people with serious health conditions.


Why should I complete a POLST form?

The POLST form can help you make sure your wishes for care are known and respected. It provides a doctor’s order which is required for emergency medical personnel (EMS) and other healthcare workers to follow your plan.


If I have a POLST form, do I need an advance directive too?

Yes, it is recommended that you also have an advance directive. The POLST form reinforces the wishes you express in your advance directive and presents them in an easy to understand way.


What information is on the POLST form?

The form includes information about an individual’s wishes regarding comfort measures, cardiopulmonary resuscitation (CPR), tube feedings and antibiotics in the last stages of an illness.


Who must sign the POLST form?

A physician, nurse practitioner of certified physician assistant (PA-C) must sign the bright pink form for it to be a physician order that is understood and followed by other healthcare professionals.


What if I want to change something on my POLST form?

The POLST orders can be changed by you and your doctor at any time.


What if I can no longer communicate my wishes for care?

Your designated healthcare representative can speak on your behalf, working with a physician to complete the POLST form.


How is the POLST form used?

The POLST form is kept near you at all times, usually on your refrigerator or by your bed if you are at home, or in your medical chart if you are in a care facility. It remains with you if you are transported between care settings to assure you receive the treatments you wish.


How do you obtain a POLST?

You can get a copy of the POLST form from your doctor or other healthcare provider, or download it from the Pennsylvania Department of Health’s web site.


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