Texas POLST Form Instructions for Health Care Providers
The Texas POLST Form is a medical order designed for patients with serious illnesses. It guides health care providers in ensuring patient treatment preferences are honored. This form is crucial for advance care planning and treatment discussions.
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How do I fill this out?
To fill out the Texas POLST Form, begin by having an open conversation with the patient or their representative about treatment preferences. Ensure that all sections are addressed according to the patient's health goals. Once completed, have the patient or representative sign and date the form to validate it.

How to fill out the Texas POLST Form Instructions for Health Care Providers?
1
Discuss treatment options and preferences with the patient.
2
Complete all relevant sections of the POLST form.
3
Ensure the patient or representative understands the form is voluntary.
4
Obtain signatures from the patient and health care provider.
5
Store the completed form in the patient's medical record.
Who needs the Texas POLST Form Instructions for Health Care Providers?
1
Patients with serious medical conditions who need to communicate their treatment preferences.
2
Health care providers needing directives to guide treatment decisions.
3
Families of patients wanting to ensure their loved ones' wishes are known.
4
Hospice care teams to facilitate end-of-life care discussions.
5
Legal representatives or guardians responsible for making medical decisions.
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How do I edit the Texas POLST Form Instructions for Health Care Providers online?
You can easily edit the Texas POLST Form on PrintFriendly by opening the document in our PDF editor. The editor allows you to modify the text, input patient information, and update treatment options seamlessly. Once your changes are made, you can download the updated PDF for your records.
1
Open the Texas POLST Form in the PrintFriendly PDF editor.
2
Click on the fields you wish to edit and make your changes.
3
Review the form to ensure all necessary information has been updated.
4
Save your changes to the document.
5
Download the edited PDF for your records or further sharing.

What are the instructions for submitting this form?
To submit the Texas POLST Form, it should be attached to the patient's medical record and shared with relevant health care providers. You may also email a scanned copy to the patient's primary care physician or hospice agency. Ensure to follow state-specific guidelines for submission and storage of this medical order.
What are the important dates for this form in 2024 and 2025?
For the Texas POLST Form, it's essential to keep track of any legislative updates in 2024 and 2025. The form itself does not expire, but reviews should occur annually or when health status changes occur. Additionally, note any changes in health care laws or guidelines that might affect its usage.

What is the purpose of this form?
The purpose of the Texas POLST Form is to ensure that patients with serious medical conditions can communicate their care preferences clearly. It acts as a medical order that facilitates discussions between patients, health care providers, and family members about treatments and interventions. By using this form, patients can receive care that aligns with their values and wishes, especially during critical health situations.

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

- 1. Patient Information: Includes fields for the patient's name, date of birth, gender, and social security number.
- 2. Cardiopulmonary Resuscitation Orders: Specifies whether to attempt resuscitation in the event of no pulse or breathing.
- 3. Initial Treatment Orders: Details the types of treatments to be administered if the patient has a pulse.
- 4. Medically Assisted Nutrition: Records preferences regarding nutrition and hydration.
- 5. Signatures: Provides space for signatures from both the patient (or representative) and health care provider.
What happens if I fail to submit this form?
Failing to submit the Texas POLST Form could result in care that does not align with the patient’s treatment preferences. Health care providers may not be aware of critical directives that guide crucial medical decisions.
- Lack of Clarity: Without submission, there may be misunderstandings about the patient's wishes.
- Misaligned Care: Patients may receive unwanted or ineffective treatments.
- Family Confusion: Family members may be uncertain about the patient's preferences, which can lead to conflict.
How do I know when to use this form?

- 1. End-of-Life Discussions: Used to ensure that care aligns with the patient's desires at the end of life.
- 2. Emergency Care Settings: Helps inform emergency responders of the patient's treatment wishes.
- 3. Hospice Care: Guides hospice teams in providing appropriate care based on the patient's goals.
Frequently Asked Questions
What is the Texas POLST Form used for?
The Texas POLST Form helps patients communicate their treatment preferences to health care providers.
Who can fill out the POLST Form?
Only licensed health care providers can complete the Texas POLST Form.
How do I edit the POLST Form on PrintFriendly?
Simply open the form in our PDF editor and modify any fields as needed.
Can I sign the POLST Form electronically?
Yes, PrintFriendly allows for electronic signatures to be added to the POLST Form.
What should I do if I need to void the POLST Form?
Contact the health care provider to void the orders and destroy the paper form.
How do I share the POLST Form?
You can share the edited POLST Form via email or social media directly from PrintFriendly.
What happens if I don't submit the POLST Form?
Without the form, health care providers may not be aware of the patient's treatment preferences.
When should the POLST Form be reviewed?
It should be reviewed during care transitions or significant health status changes.
Can I get a new POLST form if I need to make changes?
Yes, void the old form and complete a new POLST Form to reflect updated preferences.
Where can I find more information about the POLST?
Visit the website provided in the form for additional resources and guidance.
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