National POLST Form Guide Overview
This guide provides detailed information about the National POLST Form, which helps seriously ill or frail patients communicate their medical treatment preferences. It is essential for healthcare professionals to recognize and honor this portable medical order. Understanding the POLST process can significantly improve patient care and ensure preferences are respected.
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How do I fill this out?
Filling out the National POLST Form involves straightforward steps. Begin by understanding the critical choices that need to be made regarding your medical treatment preferences. Ensure accurate information is provided to facilitate effective communication with healthcare providers.

How to fill out the National POLST Form Guide Overview?
1
Read the instructions carefully before starting.
2
Fill in your personal information completely and accurately.
3
Choose your preferences for CPR and initial treatments.
4
Sign the form and date it appropriately.
5
Consult with your healthcare provider for validation.
Who needs the National POLST Form Guide Overview?
1
Patients with serious illnesses need this form to communicate their treatment wishes.
2
Family members of patients need it to ensure their loved ones' preferences are honored.
3
Healthcare providers require it to follow the patient's medical orders accurately.
4
Caregivers need it to provide appropriate care according to the patient's wishes.
5
Individuals planning for future healthcare scenarios need it for advanced planning.
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What are the instructions for submitting this form?
To submit the National POLST Form, please send a completed copy to your healthcare provider's office via email or fax. You can also deliver a hard copy in person for validation. Ensure that your provider's details are correct: for email, use admin@polst.org; for fax, consult your provider for their specific number. Always follow up with your physician to confirm that your preferences have been documented correctly.
What are the important dates for this form in 2024 and 2025?
The National POLST Form was first released on September 3, 2019, and has been updated periodically to reflect current healthcare practices. Important updates and changes will follow in 2024 and 2025, reflecting ongoing improvements in patient care processes. Stay informed about these changes as they directly affect how you utilize the POLST Form.

What is the purpose of this form?
The purpose of the National POLST Form is to provide a straightforward way for patients with serious medical conditions to express their treatment preferences. It facilitates communication between patients and healthcare providers, ensuring that wishes are honored across different care settings. By standardizing the process, the POLST Form enhances patient autonomy and the quality of care received.

Tell me about this form and its components and fields line-by-line.

- 1. Patient Information: Includes personal details such as name, date of birth, and relevant medical history.
- 2. CPR Orders: Specifies the patient's wishes regarding cardiopulmonary resuscitation.
- 3. Initial Treatment Orders: Details the types of treatments the patient consents to during medical emergencies.
- 4. Additional Instructions: Allows for additional personalized instructions from the patient.
- 5. Signature: Requires the patient's or their representative's signature to validate the form.
What happens if I fail to submit this form?
If the National POLST Form is not submitted, there may be confusion or miscommunication regarding the patient's treatment preferences. This can lead to treatments that the patient did not want or expect. It's crucial to ensure submission to avoid such complications.
- Misalignment with Patient Wishes: Healthcare providers may act contrary to the patient's preferences if the form is not submitted.
- Increased Stress for Family Members: Family and friends might face added emotional stress during medical emergencies due to unclear directives.
- Legal Complications: Inaccuracies or absence of a medical order may lead to legal issues in honoring the patient's wishes.
How do I know when to use this form?

- 1. During Medical Emergencies: To guide healthcare providers on the patient's treatment preferences when immediate action is required.
- 2. End-of-Life Planning: To ensure that the patient’s wishes are respected as they approach end-of-life scenarios.
- 3. When Transitioning Between Care Settings: To maintain continuity of care and ensure that treatment preferences are honored wherever the patient receives care.
Frequently Asked Questions
What is the National POLST Form?
The National POLST Form is a portable medical order that helps patients communicate their treatment preferences.
How do I fill out the National POLST Form?
To fill out the form, follow the instructions provided and ensure to consult your healthcare provider.
Can I edit the National POLST Form?
Yes, you can edit the National POLST Form on PrintFriendly before downloading.
Is the POLST form the same in every state?
No, each state has its own regulations and formats for POLST forms.
Who should complete the POLST Form?
The form should be completed by patients with serious illnesses or their healthcare representatives.
What happens if I don’t submit the POLST Form?
Failing to submit the POLST Form can lead to confusion regarding your treatment preferences.
How can I share my POLST Form with healthcare providers?
You can share the POLST Form easily through PrintFriendly by sending it via email or sharing a direct link.
Where can I find support for filling out this form?
You can contact healthcare professionals for guidance or refer to the instructions provided in this guide.
Is there a cost associated with using PrintFriendly to edit my PDF?
Editing your PDF on PrintFriendly is free and straightforward.
Can I save my changes to the POLST Form?
You can download the edited POLST Form after making changes but currently cannot save it on the site.
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