You may download the POLST Form here. You may also obtain the POLST form from your doctor or other health care providers.
No. POLST is voluntary and has only been available in Hawaii since July 2009.
Yes. A doctor must sign the form. It then becomes a provider order that is followed by other health care professionals, including EMS personnel. The form also requires the signature of the person for whom the form is being completed or his/her health care power of attorney or surrogate decision maker.
Through an advance health care directive, you should appoint a health care power of attorney who can speak on your behalf in case you’re no longer able to speak for yourself. A doctor can complete the POLST form with your health care power of attorney or surrogate decision maker based on their understanding of your wishes.
If you have a signed POLST form, it is highly recommended that you also have an advance health care directive, though it is not required. An advance health care directive is the best way to appoint a health care power of attorney. The POLST form is not the tool to appoint this person. You may obtain more information about advance health care directives on our Advance Health Care Directive page.
The completed, signed POLST form is a provider order that will remain with you if you are transported between care settings, regardless of whether you are in the hospital, at home or in a long-term care facility. The POLST form may be used to convey your wishes to paramedics who arrive after 9-1-1 has been called.
If you live at home, you should keep the original green POLST form in a location where it can easily be seen. The ideal place is on your refrigerator where EMS personnel will look for it first. Other visible places could be the back of the bedroom door, on a bedside table, or in your medicine cabinet. If you reside in a long-term care facility, your POLST form may be kept in your medical chart along with other medical orders.
The form is brightly colored so it can easily be found when needed and will be honored by health care providers, including EMS personnel. However, a black & white copy of the completed form is still valid and legal.