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