Understanding POLST Forms for Peace of Mind
This document provides insights into POLST forms, which communicate patients' treatment preferences in medical emergencies. It includes important stories, guidelines, and comparisons with Advance Directives. Learn how to navigate this essential tool for healthcare decision-making.
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How do I fill this out?
To fill out the POLST form, first, consult with your healthcare provider to discuss your treatment preferences. Next, clearly state what medical treatments you wish to receive or refuse in emergency situations. Finally, ensure your provider signs the form to make it a valid medical order.

How to fill out the Understanding POLST Forms for Peace of Mind?
1
Consult with your healthcare provider.
2
Discuss your treatment preferences.
3
Clearly state your wishes on the form.
4
Ensure your healthcare provider signs it.
5
Keep a copy accessible for emergencies.
Who needs the Understanding POLST Forms for Peace of Mind?
1
Individuals diagnosed with serious illnesses who want clear medical orders.
2
Elderly patients wishing to express their treatment preferences.
3
Patients undergoing significant medical procedures seeking peace of mind.
4
Family members wanting to ensure their loved one's wishes are adhered to.
5
Anyone looking to update their medical records to reflect current wishes.
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What are the instructions for submitting this form?
To submit your POLST form, please provide it to your healthcare provider, who will ensure it is included in your medical records. You may also share a copy with family members and emergency contacts. It is vital to maintain an accessible copy of your POLST form for quick reference during medical emergencies.
What are the important dates for this form in 2024 and 2025?
Currently, there are no specific deadlines for POLST submissions. However, it's advisable to review and update your POLST form annually or after any significant change in health status. Always consult with your healthcare provider for guidance on your POLST needs.

What is the purpose of this form?
The purpose of the POLST form is to facilitate communication between patients and healthcare providers regarding treatment preferences. It ensures that wishes are legally documented and respected in emergency situations. By having a POLST form, patients can take control over their medical care and alleviate stress for their loved ones.

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

- 1. Patient Information: Contains personal details such as name, date of birth, and medical record number.
- 2. Treatment Preferences: Outlines specific treatments the patient wishes to receive or decline.
- 3. Signature Section: Requires the signatures of both the patient and healthcare provider to validate the document.
What happens if I fail to submit this form?
If you fail to submit the POLST form correctly, your treatment preferences may not be honored in emergency situations. It is crucial to ensure that the form is filled out accurately and shared with relevant medical personnel.
- Misperception of Treatment Preferences: Emergency personnel may undertake aggressive treatments that you did not wish for.
- Family Disagreement: Family members may struggle to make decisions on your behalf without clear guidance.
- Increased Stress: Not having a clear POLST form can lead to confusion and distress for loved ones during emergencies.
How do I know when to use this form?

- 1. Serious Illness Management: For patients diagnosed with terminal illnesses to ensure their care preferences are followed.
- 2. Post-Surgery Decisions: To establish wishes related to care after major medical procedures.
- 3. Long-term Care Planning: For individuals in long-term care facilities who may face medical emergencies.
Frequently Asked Questions
What is a POLST form?
A POLST form is a medical order that outlines a patient’s treatment preferences during a medical emergency.
Who should complete a POLST form?
Individuals with serious illnesses or those who wish to specify their medical treatment preferences should complete a POLST form.
How does PrintFriendly improve filling POLST forms?
PrintFriendly allows for easy editing and signing of POLST forms, making the process more efficient.
Can I change my POLST form later?
Yes, you can revise your POLST form at any time with your healthcare provider.
What happens if my wishes are not followed?
A properly filled POLST form serves as a medical order, ensuring your preferences are adhered to.
Why is a POLST form important?
It provides clear communication of your treatment wishes, reducing confusion during emergencies.
Are POLST forms legally binding?
Yes, once signed by a physician, POLST forms are considered medical orders.
What information do I need to complete my POLST?
You need to discuss treatment options with your healthcare provider to complete the POLST accurately.
How will my POLST be shared with emergency responders?
Once completed, your POLST information can be added to medical records and accessible by emergency services.
What should I do after filling out my POLST?
Ensure to keep copies accessible and discuss your wishes with family members.
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