Frequently Asked Questions About POLST

POLST stands for “portable medical orders.” Nationally, POLST is not an acronym (but it used to be). States use different letters and call their program by different names: view the complete list.

POLST is part of advance care planning intended for people who are seriously ill or who have advanced frailty. It starts with a talk between the person and their health care provider and can lead to a portable medical order, or POLST form.

A POLST form is a portable medical order. The POLST form is how patients who are seriously ill or have advanced frailty tells all health care providers what they want during an emergency and what their goals of care are given their current medical condition.

Orders on a POLST form include:

• Whether you want cardiopulmonary resuscitation (CPR) attempted
• Whether you want to go to the hospital or stay where you are
• Whether you want to receive care in an intensive care unit and be on a breathing machine, if needed

The POLST form is also a way to share your general goals of treatment. These help providers make sure any other medical treatments you may need that aren’t covered on the POLST match your goals.

If you are seriously ill or have advanced frailty you may want to talk with your provider about having one. The current standard of care during an emergency is for emergency medical services (EMS) to attempt everything reasonably possible to attempt to save a life. Not all patients who are seriously ill or frail want this treatment and POLST provides the option for them to:

1. confirm this is the treatment they want or
2. to say what level of treatment they do want.

Beyond emergencies, a POLST tells health care providers what treatments you want and your goals of care so they can match treatments to your goals if you are unable to communicate.

If you are healthy, an advance directive is appropriate.

From your health care provider. Since the POLST form is a medical order, it should be completed and signed by your provider.

A POLST form is a medical order that should be completed by your provider. Patients should not be provided a POLST form to complete on their own. A POLST form should never be completed without a conversation with the patient, or his/her surrogate, about diagnosis, prognosis, treatment options and goals of care.

Yes. Your provider must sign the form in order for it to be valid. Most states, and the National POLST Form, also require the patient or the patient’s surrogate (or proxy, health care agent, representative) to sign as well.

You and your provider should have talked about what treatments you want prior to your getting a POLST form so hopefully you know. If you want a reminder or something to help you share what your form means with others, see our “What Your POLST Form Means” guide. This guide goes with the National POLST Form so your POLST form may look a little different.

Your provider will give you the original copy of your POLST and will keep a copy in your medical record.

• Carry your POLST with you if you go to a facility.
• If you are home, post it on your refrigerator or put it in your medicine cabinet. Emergency personnel will look for it those places.
• Tell your family and friends you have a POLST form so they can tell emergency personnel to look for it.
• If you are traveling, keep a copy in your purse or wallet near your ID. Emergency personnel will look there to find it.

If you are in a health care setting like a hospital or nursing home, your POLST form will be in your chart. You will be given your original POLST form if you go from one care setting to another.

In almost all states, yes.

Some states prohibit providers signing POLST forms for healthy patients. In other cases, providers may be uncomfortable signing a POLST form if they do not know the patient well or are uncomfortable with the choices the patient is making. POLST forms are medical orders and providers can be held accountable if they inappropriately sign a POLST form, just like if they inappropriately sign any other medical order or prescription.

Yes. POLST forms do not just guide care during emergencies. The goals of care and medical interventions selected on the form are used to guide decisions regarding artificial nutrition, the use of antibiotics and the provision of other treatments for the patient.

The POLST form is intended for any patient who is seriously ill or has advanced frailty. For patients with significant disabilities, POLST should be considered only when the patient’s level of functioning has become severely impaired as a result of a deteriorating health condition and when intervention will not significantly impact the process of decline.

It is not common for providers to complete POLST forms for healthy individuals and a few states prohibit a provider from completing a POLST form unless their patient is seriously ill or has advanced frailty. Therefore, this is something you need to discuss with your provider since it is their medical license that is at risk for signing a POLST form (medical order).

POLST was created to help people who have a medical condition that means they expect to have a medical emergency at some point. These people, because they are sick and/or frail, are able to have a specific conversation with their provider about what treatment options are available to them and what it will mean for them. For example, if a patient has a chronic heart condition, they can talk to their provider about what will happen if they have a heart attack (expected for their condition) and what will likely happen if they have CPR or are transferred to the intensive care unit (ICU).

If you are healthy, the standard of care is to provide all reasonable treatment possible to attempt to save your life. There is no need to complete a POLST form to get this level of treatment