POLST Forms For California

A POLST (Physician Orders for Life-Sustaining Treatment) form is a medical order designed to communicate a patient’s preferences regarding life-sustaining treatments in California. It is intended for individuals with serious illnesses or those who are in frail health and want to ensure their treatment preferences are honored by healthcare providers. I will provide a link to download POLST forms for California below.

The POLST form is different from an advance directive in that it is a medical order and is actionable by emergency personnel, while an advance directive is a legal document that might require interpretation.

Key Elements of a POLST Form

A POLST form is important if you want medical personnel to understand your preferences for life-sustaining treatments in California. Key elements of the form include:

1. Patient’s Information: Includes the patient’s name, date of birth, and contact information.
2. Medical Orders:
3. • Section A: Cardiopulmonary Resuscitation (CPR) – Indicates whether the patient wants CPR or not if they are found without a pulse and not breathing.
   • Section B: Medical Interventions – Outlines the desired level of medical intervention, such as:
   • • Full Treatment: This includes all measures necessary for survival.
     • Selective Treatment: This includes measures like IV fluids and medications, but avoids intensive care.
     • Comfort-Focused Treatment: This focuses on relief from pain and symptoms without aggressive interventions.
3. Artificially Administered Nutrition: Here is where you specify preferences for feeding tubes and other forms of artificial nutrition.
4. Signatures: The form must be signed by both the patient (or their legally recognized representative) and a healthcare provider (physician, nurse practitioner, or physician assistant) to be valid.

Purpose and Use

• Ensures Clarity: The form clearly communicates the patient’s wishes to all healthcare providers.
• Portability: The POLST form is recognized and honored across different healthcare settings, including hospitals, nursing homes, and by emergency responders.
• Immediate Action: Acts as a set of medical orders that can be immediately acted upon by healthcare providers.
• Color it Pink: It is recommended that the POLST form be copied on bright pink paper to help ensure that the document stands out and is followed. However, POLST on any color paper is valid.

Obtaining and Completing a POLST Form

• Discuss with Healthcare Provider: Patients should discuss their health condition, treatment options, and personal values with their healthcare provider to make informed decisions.
• Fill Out the Form: The form can be completed during a medical appointment with a healthcare provider.
• Review and Update: It’s important to review and update the POLST form regularly or if the patient’s health status or preferences change.