Georgia POLST Instructions and Form
This file contains detailed instructions and the official form for the Physician Orders for Life-Sustaining Treatment (POLST) in Georgia. It guides users on how to complete the form and outlines important legal information. It is intended for patients, caregivers, and medical professionals.
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How do I fill this out?
To fill out the Georgia POLST form, you need the patient's personal information, medical preferences, and signatures from authorized individuals. Carefully read each section and fill it according to the patient’s wishes. Ensure all necessary signatures are provided to make the form valid.
How to fill out the Georgia POLST Instructions and Form?
1
Collect patient's personal information.
2
Indicate the patient's medical intervention preferences in sections A through D.
3
Include any additional orders regarding antibiotics, nutrition, or fluids.
4
Ensure signatures from the physician, concurring physician if needed, and the patient or authorized person.
5
Review and confirm the filled-out form for accuracy.
Who needs the Georgia POLST Instructions and Form?
1
Patients with serious illnesses who need to express their treatment preferences.
2
Authorized persons representing patients who lack decision-making capacity.
3
Medical professionals who need to understand and respect a patient’s treatment wishes.
4
Caregivers managing the care of seriously ill or incapacitated patients.
5
Hospitals and healthcare facilities requiring documentation of patient preferences.
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Review and save the edited document.
What are the instructions for submitting this form?
The completed POLST form should be submitted to the patient's healthcare provider and kept in an accessible location. Copies should be provided to the patient's authorized person, family members, and any healthcare facility where the patient is receiving care. Email submissions should be directed to the patient’s primary healthcare provider. Fax submissions can be sent to the healthcare provider's fax number. It is also advisable to keep a copy at home where emergency responders can easily find it.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, the Georgia POLST form remains relevant for patients needing end-of-life care planning throughout these years.
What is the purpose of this form?
The purpose of the Georgia POLST form is to provide a clear and concise way for patients with serious illnesses to communicate their preferences for life-sustaining treatments. It ensures that healthcare professionals and caregivers understand and respect the patient's wishes, especially in emergencies. The form is legally recognized and provides critical guidance for medical interventions, comfort measures, and other treatment decisions.
Tell me about this form and its components and fields line-by-line.
- 1. Patient's Name: Full legal name of the patient.
- 2. Date of Birth: Patient’s date of birth.
- 3. Gender: Patient’s gender.
- 4. Code Status: Indicates whether CPR should be attempted or natural death allowed.
- 5. Medical Interventions: Specifies the level of medical intervention desired.
- 6. Antibiotics: Provides choices for antibiotic use.
- 7. Artificially Administered Nutrition/Fluids: Options for artificial nutrition and fluids.
- 8. Signature Section: Includes areas for patient, authorized person, and physician signatures.
- 9. Additional Orders: Any other specific medical orders or preferences.
- 10. Review Section: Dates and details for subsequent reviews of the form.
What happens if I fail to submit this form?
Failure to submit the Georgia POLST form can result in the patient's treatment preferences not being honored in critical situations. It is important to ensure that the form is completed, signed, and available to healthcare providers.
- Unclear Medical Preferences: Without a submitted POLST form, healthcare providers may not know the patient's wishes, leading to unwanted treatments.
- Legal Issues: Lack of a POLST form can result in legal complications if the patient's treatment preferences are not documented.
- Increased Stress: Patients and families may experience increased stress and confusion during medical emergencies without a POLST form.
How do I know when to use this form?
- 1. Serious Illness: When the patient has a condition that may result in death within the next year.
- 2. Dementia Diagnosis: For patients diagnosed with dementia or other progressive, degenerative brain conditions.
- 3. Medical Intervention Preferences: To specify desired and undesired medical interventions and treatments.
- 4. End-of-Life Planning: For documenting preferences for end-of-life care and resuscitation.
- 5. Authorized Person Representation: When an authorized person needs to make medical decisions for a patient who cannot do so themselves.
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