POLST Form

What Is POLST Form?

The POLST form (Physician Orders for Life-Sustaining Treatment) is a doctor’s medical order for seriously ill patients specifying their end-of-life treatment wishes. It’s a bright pink portable form that emergency teams must follow for CPR, hospital transfer, or comfort care preferences. Download the free POLST form PDF template to honor patient wishes during medical emergencies.

Purpose Of The POLST Form

This form ensures seriously ill patients receive exactly the care they want when they can’t speak for themselves. Doctors create POLST orders after discussing treatment goals with patients, making wishes legally binding across hospitals, ambulances, and nursing homes during patient admission. It prevents unwanted aggressive treatments and guides emergency responders clearly, working alongside advance health directive forms.

Key Components Of A POLST Form

These simple checkboxes tell emergency teams exactly what the patient wants – no confusion during critical moments.

• CPR Orders: Check “Yes” or “No CPR” if heart stops.
  
• Treatment Level: Comfort care only, limited treatment, or full treatment.
  
• Antibiotics: Yes for infections or no antibiotics.
  
• Tube Feeding: Long-term feeding tube or no tube feeding.
  
• Doctor Signature: Makes orders legally binding.
  
• Patient Name: Who the orders are for.
  
• Doctor Contact: Emergency teams call this number.
  
• Date Created: When orders were made.
  
• Review Date: When to check if wishes changed.
  
• Patient Signature: Patient agrees with doctor’s orders.
  

Digitize Your Medical Forms with Emitrr

Paper POLST forms get lost in emergencies when seconds count. Emitrr digitizes POLST completely – patients review preferences on phones via HIPAA-compliant forms via text, physicians e-sign orders instantly, and forms sync to patient medical records accessible by ambulance teams nationwide. Bright digital POLST lives in EHR systems, always available during crises.

Emergency responders scan QR codes on digital POLST for instant access – no hunting through paper charts. Families get immediate confirmation texts when orders complete, while automated texting reminds physicians to review orders every 6 months as health changes.

Emitrr’s HIPAA-compliant platform stores POLST with full audit trails showing every discussion, signature, and update. During hospice transitions or hospital transfers, digital POLST follows automatically through EHR integration. No more “Does this patient have a POLST?” confusion.

Explore 100+ end-of-life templates in Emitrr’s free medical forms library. Built for the most critical moments when clear orders save lives and honor wishes perfectly.

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