Physician Orders for Life-Sustaining Treatment (POLST)

The POLST (Physician Orders for Life-Sustaining Treatment) form is intended for any individual with serious health conditions.

The POLST form asks for information about:

  • Your preferences for resuscitation
  • Medical conditions
  • The use of antibiotics
  • The use of artificially administered fluids and nutrition

The POLST form will translate your wishes as expressed in your health care directive and/or Durable Power of Attorney into clear and specific medical orders.  This will assist physicians, nurses, health care facilities and emergency personnel in providing appropriate treatment.

A POLST form can be obtained at your physician's office. It must be signed by both you and your physician before it is valid.