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 model 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. The National POLST form is a model template for states to develop their state-specific form.

Information for Professionals

National POLST Model Form

Check with your contact about the form used in your state or DC.

A copy of this publication may be downloaded, stored, or printed for personal use only; all other uses require written permission.

POLST Form Guide for Professionals

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

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.

Template for Review Chart

For facilities wishing to create a review document for POLST forms.

Foreign Language Versions

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

Why have a National Model 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.

Patient Guide 2

What Your Completed POLST Form Means

Chart: POLST vs. Advance Directives

Explains how these two advance care planning tools differ.

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.