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National POLST Form: Portable Medical Order

National Form | Information for Professionals | Patient Guides | Translations | Learn more

The National POLST Form was created because having a single form will make it easier to:
  1. Honor patient treatment wishes throughout the United States
  2. Conduct research and quality assurance activities to improve the POLST form
  3. Educate about POLST so it is properly used everywhere
The National POLST Form, first published August 2019, represents a major step towards national consensus on a POLST form — and many consecutive months of interviews and listening, consensus building, feedback, compromise, and iterative revisions.

Information for Professionals

National POLST Form

Check with your contact (www.polst.org/programs) about whether this is the form used in your state or DC

Download

How to Order the National POLST Form

Visit your program website or reach out to your program contact to order POLST forms. Forms are not available to individuals since they are medical orders that should be completed by providers.

Foreign Language Versions

We are planning to offer foreign language translations of the National POLST form. Learn more.

POLST Form Guide for Professionals

National POLST Form Guide for Professionals (PDF, 39 pages)

Download

Template for Review Chart

For facilities wishing to create a review document for POLST forms

Download

Why have a National Form?

POLST programs have developed separately in each state, resulting in inconsistencies among different state forms. Read more in this article from the National Hospice and Palliative Care Organization (NHPCO)'s Fall 2021 newsletter.

National POLST Patient Guides

Download our guides below. Patient Guide 1 helps prepare your for talking with your health care provider about POLST. Patient Guide 2 helps explain what your completed POLST form means. For more in-depth patient educational materials, please see our patient web page about the POLST form.

Patient Guide 1

Getting Ready to Talk About POLST

Download

Patient Guide 2

What Your Completed POLST Form Means

Download
https://www.youtube.com/watch?v=ci7KlDJQpFU

Chart: POLST vs. Advance Directives

Explains how these two advance care planning tools differ

Download

Learn more

Please remember that POLST is meant to be centered about conversations between the patient and their health care provider. Patient information is available at our patient-facing pages.

Contact Us

  • 208 I Street NE
  • Washington DC 20002
  • (202) 780-8352
Comments? Questions? Email us.

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The National POLST Office produces approximately 10 eNewsletters per year that include news about POLST, resources for POLST Programs, and the latest research on end-of-life issues.

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