POLST Form: A Complete Guide for Healthcare Professionals
Updated October 18, 2026 · Advance care planning · Training & Documentation
FIG · 01POLST Form at a Glance
Portable Medical Order
A medical order, not an advance directive, signed by a licensed provider and honored by EMS
50 States + D.C.
List a POLST program in the National POLST Collaborative directory
Travels With You
Valid across care settings: home, hospital, EMS, nursing facility
A POLST form — POLST now stands for “portable medical orders” (it originally stood for Physician Orders for Life-Sustaining Treatment) — is a medical order that translates a seriously ill patient’s treatment preferences into actionable instructions that first responders, hospitals, and nursing facilities must follow. Unlike an advance directive, which is a legal document anyone can prepare, a POLST is a clinical order signed by both the patient (or their surrogate) and a qualified healthcare provider.
For healthcare staff, understanding POLST is essential. It intersects with informed consent procedures, patient rights, and documentation workflows. This guide covers what the form contains, who should have one, how it differs from advance directives and healthcare power of attorney, and how to discuss it with patients and families.
FIG · 02POLST vs. Advance Directive
Both documents express treatment preferences, but they serve different purposes and have different legal weight. A POLST is not a substitute for an advance directive or HIPAA authorization — patients should ideally have both.
| Dimension | POLST Form | Advance Directive |
|---|---|---|
| Document type | Medical order (signed by a provider) | Legal document (signed by the individual) |
| Who should have one | Seriously ill or advanced frailty patients | Every adult age 18+ |
| Appoints a surrogate | No | Yes (healthcare power of attorney) |
| Honored by EMS | Yes — EMTs must follow POLST orders | No — EMTs generally cannot interpret advance directives |
| CPR instructions | Yes — explicit attempt/do-not-resuscitate order | May express wishes but not as a direct order |
| Portability | Follows patient across all care settings | Must be located and interpreted by providers |
| Who completes it | Healthcare provider + patient/surrogate together | Individual (may consult attorney) |
| Can be changed | Yes — new form replaces old at any time | Yes — can be revoked or amended |
| Replaces the other | No — complements an advance directive | No — complements a POLST |
Key takeaway for staff
When a patient presents with both a POLST and an advance directive, the POLST takes precedence for the specific treatments it covers (CPR, medical interventions, antibiotics). The advance directive governs everything else and designates the surrogate decision-maker.
Who Should Have a POLST
POLST is not for everyone. It is specifically designed for people whose current health status makes it likely they will need emergency medical decisions in the near future. The National POLST form describes it as being for patients at risk of a life-threatening clinical event because of a serious life-limiting condition, which may include advanced frailty. Many clinicians use the “surprise question” as a quick screen:
“Would I be surprised if this patient died within the next year?”
If the answer is no, POLST is appropriate. If yes, an advance directive alone is sufficient.
Appropriate for POLST
- Patients with serious, life-limiting illness (e.g., advanced cancer, end-stage heart failure, advanced COPD)
- Patients with advanced frailty due to aging, regardless of specific diagnosis
- Nursing home or long-term care residents with declining functional status
- Patients whose clinician would not be surprised if they died within the next year
- Patients receiving hospice or palliative care services
Not appropriate for POLST
- Healthy adults — an advance directive is sufficient
- Healthy minors — for a seriously ill child, check whether your state’s form allows a parent or guardian to complete it
- Patients who have not had a goals-of-care conversation with their provider
Healthcare facilities should integrate POLST screening into their patient intake process. Asking about existing advance directives and POLST forms during admission ensures treatment preferences are documented before an emergency occurs.
What the POLST Form Covers
While state-specific forms vary slightly in format, the National POLST form is organized into six sections (A through F). Each addresses a different clinical decision a provider may encounter.
Section A
Cardiopulmonary Resuscitation (CPR)
Applies only when the patient has no pulse and is not breathing. Two options: YES CPR (attempt resuscitation, including mechanical ventilation, defibrillation and chest compressions) or NO CPR (do not attempt resuscitation). This section is the most critical for EMS personnel to locate quickly.
Section B
Initial Treatment Orders
Applies when the patient has a pulse and/or is breathing. Three tiers: full treatments (all indicated medical and surgical care, including intensive care), selective treatments (antibiotics, IV fluids and non-invasive airway pressure as indicated, avoiding intensive care where possible), or comfort-focused treatments (symptom management, transfer to hospital only if comfort cannot be achieved where the patient is).
Section C
Additional Orders or Instructions
Free-text orders that add to Sections A and B, such as preferences about blood products or dialysis. EMS protocols may limit what emergency responders can act on here, so keep the critical decisions in Sections A and B.
Section D
Medically Assisted Nutrition
Records the choice about feeding tubes: provide nutrition through a new or existing tube, a time-limited trial, no tube feeding, or not discussed. Food by mouth is offered if the patient wants it and tolerates it.
Sections E and F
Signatures
Section E is signed by the patient (or legally authorized surrogate) and Section F by a licensed health care provider authorized to sign POLST forms in that state. Both signatures are required. Some states add their own witness or other requirements.
Section A and Section B must be consistent
On the National POLST form, choosing “YES CPR” in Section A requires “Full Treatments” in Section B. A patient who chooses “NO CPR” may pick any option in Section B. Providers should flag and discuss any mismatch during the conversation.
How to Complete a POLST Form
Completing a POLST is a clinical process, not a paperwork exercise. The conversation is the form — the document simply records what was decided. Facilities should ensure this process is part of their documented risk assessment and quality improvement workflows.
Confirm the patient meets POLST criteria
The patient should have a serious life-limiting illness or advanced frailty that puts them at risk of a life-threatening clinical event. Healthy individuals should complete an advance directive instead.
Conduct a goals-of-care conversation
Discuss prognosis honestly. Ask what matters most: length of life, quality of life, being at home, avoiding certain treatments. Document the conversation in the medical record.
Complete each section of the form together
Walk through Sections A–D with the patient or surrogate. Use plain language. Explain realistic outcomes for CPR, intubation, and hospitalization given the patient’s specific condition and functional status.
Obtain required signatures
Both the patient (or authorized surrogate) and a qualified healthcare provider must sign the form. Check your state’s requirements — some states require additional witnesses or allow nurse practitioners and physician assistants to sign.
Distribute copies and update records
Give the original to the patient (on bright-colored paper if required by your state). Upload a copy to the EHR. Send copies to the patient’s other providers, any involved care facility, and the patient’s designated surrogate. Update the medical record to reflect current POLST status.
Schedule periodic review
Review the POLST at care transitions (hospital to home, home to facility), when the patient’s health status changes substantially, when they change primary provider, or when their goals of care change. The form does not expire, and a new form replaces the previous one.
One form per patient
A new POLST voids all previous versions. Destroy old copies to prevent confusion.
Review at transitions
Hospital discharge, facility admission, and significant health changes all trigger a POLST review.
Patient can revoke anytime
A patient with decision-making capacity can void their POLST verbally or in writing at any time.
Guide for Healthcare Staff: Discussing POLST
The quality of the POLST conversation directly determines the quality of the resulting form. A rushed or poorly explained discussion leads to forms that do not reflect true patient preferences — which can result in unwanted treatments, family disputes, and potential compliance issues.
Five-Step Conversation Framework
Step 1: Choose the right moment
Initiate the conversation during a scheduled visit, not during an acute crisis. Avoid discussing POLST while a patient is in pain, heavily medicated, or emotionally distressed. Ideal trigger points: new serious diagnosis, hospital admission for worsening condition, transition to palliative or hospice care.
Step 2: Assess understanding first
Start by asking what the patient already knows: "What has your doctor told you about where things stand with your illness?" This reveals knowledge gaps and emotional readiness. Do not assume the patient has been told their prognosis, even if it is documented in the chart.
Step 3: Include the right people
Ask the patient who they want present. This often includes a spouse, adult child, or designated healthcare proxy. If the patient lacks decision-making capacity, identify the legally authorized surrogate per your state’s hierarchy (usually spouse, then adult child, then parent).
Step 4: Walk through each section
Use plain language. Instead of "Do you want cardiopulmonary resuscitation?", say "If your heart stops beating, would you want us to try to restart it? I want you to know what that involves…" Explain realistic outcomes for each option based on the patient’s specific condition.
Step 5: Document and distribute
Both the patient (or surrogate) and the provider must sign. Place the original on brightly colored paper (often pink or lime green, per state requirements) where it will be found quickly — on the refrigerator at home, in the front of the medical chart, or in the electronic health record. Provide copies to the patient, surrogate, and all involved care facilities.
Handling Common Objections
These responses are grounded in best practices from palliative care communication training (e.g., VitalTalk, ELNEC). Adapt the language to your patient’s cultural context.
State-by-State POLST Names
Different states use different names for the same concept. The most common variations are POLST, MOLST (Medical Orders), MOST (Medical Orders for Scope of Treatment), POST (Physician or Provider Orders for Scope of Treatment), and COLST (Clinician Orders). Every state and D.C. has a program listed in the National POLST Collaborative’s state directory; “Active member” marks the programs that are currently active members of the Collaborative.
| State | Form Name | Status |
|---|---|---|
| Alabama | See state program | State program |
| Alaska | Alaska POLST | State program |
| Arizona | POLST | Active member |
| Arkansas | POLST | State program |
| California | POLST | Active member |
| Colorado | MOST | Active member |
| Connecticut | MOLST | State program |
| Delaware | DMOST | Active member |
| D.C. | MOST | State program |
| Florida | POLST | State program |
| Georgia | POLST | Active member |
| Hawaii | POLST | Active member |
| Idaho | POST | Active member |
| Illinois | POLST | Active member |
| Indiana | POST | Active member |
| Iowa | IPOST | State program |
| Kansas | TPOPP | Active member |
| Kentucky | MOST | State program |
| Louisiana | LaPOST | Active member |
| Maine | POLST | State program |
| Maryland | MOLST | State program |
| Massachusetts | MassPOLST | Active member |
| Michigan | MI-POST | State program |
| Minnesota | POLST | State program |
| Mississippi | MPOST | State program |
| Missouri | TPOPP | State program |
| Montana | POLST | State program |
| Nebraska | POLST | State program |
| Nevada | POLST | State program |
| New Hampshire | POLST | State program |
| New Jersey | POLST | State program |
| New Mexico | MOST | State program |
| New York | MOLST | State program |
| North Carolina | MOST | Active member |
| North Dakota | POLST | State program |
| Ohio | MOLST | State program |
| Oklahoma | OkPOLST | State program |
| Oregon | POLST | Active member |
| Pennsylvania | PAPOLST | Active member |
| Rhode Island | MOLST | State program |
| South Carolina | POST | Active member |
| South Dakota | MOST | State program |
| Tennessee | POST | Active member |
| Texas | Texas POLST | Active member |
| Utah | POLST | State program |
| Vermont | COLST | State program |
| Virginia | POST | Active member |
| Washington | POLST | Active member |
| West Virginia | POST | Active member |
| Wisconsin | POST | State program |
| Wyoming | WyoPOLST | State program |
Program names and membership from the National POLST Collaborative state directory (polst.org), checked October 2026. Check your state’s POLST program website for the most current form version.
POLST Quick Reference Card
Build a complete advance care planning workflow
POLST is one element of a broader patient-centered compliance framework. Ensure your informed consent forms reflect current standards, review your HIPAA compliance checklist, and confirm that all staff complete bloodborne pathogens training annually.