Utah Provider Order for Life-Sustaining Treatment
This document outlines the Provider Order for Life-Sustaining Treatment (POLST) in Utah, providing important guidelines for patients and healthcare providers. It serves as a medical order reflecting patient preferences for life-sustaining treatments. Understanding this form is crucial for ensuring appropriate medical care.
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How do I fill this out?
Filling out the Utah POLST form involves carefully considering your medical preferences and discussing them with your healthcare provider. Ensure that you fill out all the required sections and provide accurate information about your health status. Once completed, it must be signed by both you and your medical provider to be valid.
How to fill out the Utah Provider Order for Life-Sustaining Treatment?
1
Review the form and relevant medical guidelines.
2
Discuss treatment preferences with your healthcare provider.
3
Complete all sections of the form accurately.
4
Sign the form along with your medical provider.
5
Keep the original form accessible in your medical records.
Who needs the Utah Provider Order for Life-Sustaining Treatment?
1
Patients with chronic illnesses who want to outline their treatment preferences.
2
Families making decisions for loved ones who cannot voice their wishes.
3
Healthcare providers needing a clear directive for patient care.
4
Pediatric patients for whom parents seek to articulate medical decisions.
5
Individuals preparing for end-of-life care discussions with healthcare teams.
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1
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What are the instructions for submitting this form?
Submit this completed POLST form either through your healthcare provider's office or directly to the relevant medical facility. If submitting via email, ensure that the document is securely sent to the designated provider's email address. Physical submissions can be made at the facility's records office, or fax the form to the provided fax number for your healthcare provider.
What are the important dates for this form in 2024 and 2025?
It is essential to note that the Utah POLST form adheres to the regulations set forth in February 2019. Any updates or changes would be reviewed at the next scheduled review or health status update. Patients should consult with their healthcare provider for any updates to procedures relating to POLST.
What is the purpose of this form?
The purpose of the Utah POLST form is to ensure that patients receive care that aligns with their personal values and treatment preferences. This document serves as a detailed guide for healthcare providers, indicating the types of medical interventions a patient may wish to receive or decline during emergencies. By articulating these wishes, patients can have peace of mind knowing that their healthcare will reflect their desires.
Tell me about this form and its components and fields line-by-line.
- 1. Patient's Last Name: The last name of the patient.
- 2. Date of Birth: Patient's date of birth.
- 3. Effective Date of this Order: The date this POLST order becomes effective.
- 4. Medical Provider's Name: The name of the healthcare provider responsible for the order.
- 5. Patient's stated goals: Goals regarding the patient's medical care.
- 6. Signature of Medical Provider: The signature of the medical provider who completed the form.
- 7. Signature of Patient: The patient's signature indicating agreement with the order.
What happens if I fail to submit this form?
If you fail to submit the POLST form, your treatment preferences may not be clearly communicated to healthcare providers. This could lead to situations where the care provided does not align with your wishes. It is crucial to ensure this form is completed and submitted appropriately.
- Unclear Treatment Preferences: Lack of clear directives may lead to unintended treatments.
- Patient Confusion: Staff may not understand the patient's wishes without a signed document.
- Legal Ramifications: Failure to provide a formal order may complicate legal aspects of care.
How do I know when to use this form?
- 1. End-of-Life Care Planning: To provide clear guidance on desired medical interventions during end-of-life scenarios.
- 2. Chronic Illness Management: To articulate specific treatment preferences for patients with chronic conditions.
- 3. Emergency Medical Situations: To ensure that healthcare providers follow patient directives during emergencies.
Frequently Asked Questions
What is the Utah POLST form?
The Utah POLST form is a medical order that outlines patient preferences regarding life-sustaining treatments.
How do I edit the POLST form on PrintFriendly?
You can edit the form by uploading it to PrintFriendly and using our editing tools to make necessary adjustments.
Can I sign the POLST form digitally?
Yes, after editing the form, you can add your signature directly onto the document.
Is the POLST form legally binding?
Yes, the POLST form is a legally binding document if signed by both the patient and a healthcare provider.
What should I do if my health preferences change?
You should fill out a new POLST form reflecting your updated preferences and withdraw any previous forms.
How do I download the finished POLST form?
After editing, simply click the download button to save the PDF to your device.
Can I share my POLST form with family members?
Yes, you can share the form using the sharing options available on PrintFriendly.
What is the purpose of the POLST form?
The POLST form helps ensure that medical treatments align with a patient’s values and preferences, especially during critical situations.
Who can fill out the POLST form?
The POLST form should be filled out by the patient in consultation with their healthcare provider.
When should I review my POLST form?
You should review the POLST form regularly, especially when there are changes in your health status or treatment preferences.
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