What Is a POLST Form?

Physician Orders For Life-Sustaining Treatment (POLST) are instructions from your doctor to emergency responders concerning the level of care you prefer if the emergency responders find you unable to guide them.  The POLST form should go with you wherever you go for medical treatment.  Many people with POLST forms pin them to their refrigerator doors with a magnet when they are at home, in case they are unable to give them to emergency responders themselves.  One should attach to the back of your POLST form a copy of your durable power of attorney and directive to physicians (also called a “living will.”)

The POLST form begins with the question, Do you want emergency responders to attempt cardio-pulmonary resuscitation?  That is, do you want the EMS medics to shock your heart and perform cardio-pulmonary resuscitation (CPR).  If your answer is No, then the emergency responders will desist.  If your answer is Yes, then the emergency responders read the second section of the POLST form.

The second section of the POLST form indicates what level of medical intervention you prefer.  The first level is “comfort measures only,” which means the emergency personnel will make you as comfortable as possible and give you oxygen, but they will not transport you to a hospital unless they cannot make you comfortable without doing so.  The second level is “limited additional interventions,” which means that the emergency responders will give you fluids and treat you medically and monitor your heart, but they will not intubate you to assist your breathing or put you on a breathing machine.  They may help you breathe in other ways.  The emergency responders will transport you to a hospital, if indicated by your circumstance, but the hospital will avoid putting you in intensive care.

The third level of medical intervention is “full treatment,” which means they will use any means available to sustain your life and will transport you to a hospital.  The hospital will admit you to intensive care, if indicated.

Both your doctor or nurse practitioner and you must sign and date your POLST form.

On the back of the POLST form further instructions are given.  First, you name those person who can be notified of your condition, which release is required to avoid violations of the HIPAA regulations on disclosure of patient information.  Second, you instruct medical personnel about your preferences for the use of antibiotics, assisted nutrition, and any additional orders you and your doctor thing appropriate.  Your doctor or nurse practitioner must again sign and date.

The bottom half of the POLST form contains instructions to health care professionals, reminding them of best practices concerning POLST forms.  The final section of the back of the POLST form provides a place for periodic review of your POLST directives.

At Lancaster Law Office, we encourage our clients to seek POLST forms from their doctors if the client’s medical condition is critical or if the client may soon lose the ability to direct their doctor.  We do not recommend POLST forms for clients who are healthy and competent.