Do Not Resuscitate (DNR) Washington – has transitioned to POLST

Document name

Physician Orders for Life-Sustaining Treatment (POLST).  Note:” EMS-No CPR” forms will continue to be accepted.

Where do you get the form

You should request the form from your healthcare provider.

Who can request the form

The form is intended for any individual with an advanced life-limiting illness.  However, any adult can request the form.

Who signs the form

A physician, nurse practitioner or certified physician assistant and the patient must sign the form.

How do you obtain a POLST bracelet

Ask your physician or other medical personnel.

 Revoking a POLST

The patient or his or her surrogate if the patient is unable to communicate can revoke a POLST by writing VOID in large letters across the form and drawing a line thru it.

Photocopy

A copy or a fax of a POLST is legal and valid.

State info link

http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/EmergencyMedicalServicesEMSSystems/DoNotResuscitate.aspx

 

Other links

https://www.wsma.org/end-of-life-resources

http://www.vialoflife.com/

Special notes

Order a Vial of Life decal for your front door.  The decal informs an Emergency Medical Services team that a DNR or POLST has been prepared and can be found in your refrigerator.

 

 

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