Portable medical orders (POLST)
Summary
A portable medical document, or POLST, is a one-page medical form, filled out by a health-care professional, that says what a frail or seriously ill person’s care and treatment wishes are in a medical emergency. This article discusses who should fill out a POLST form, what the form does, and the difference between POLST and other end-of-life instructions such as a living will and DNR order. It also explains the steps for changing or voiding a POLST form.
What is POLST?
POLST used to stand for “Physician Orders for Life Sustaining Treatment.” Today, POLST generally refers to a “portable medical document,” because the form, often printed on brightly colored paper, travels with a person as they are moved from one health-care setting to another.
A POLST is a one-page medical form that says what a frail or seriously ill person’s wishes are in a medical emergency. These can be wishes about treatment options, pain medication, receiving CPR, being moved to a hospital, and more. A doctor or other health-care professional, such as a nurse practitioner, fills out and signs the POLST form after the person has discussed their wishes with their loved ones and health-care team.
Different states may call POLST forms different names. For example, Connecticut uses MOLST and Iowa uses IPOST.1 However, all of these forms and programs basically work in the same way.
Who should fill out a POLST form?
POLST is meant for people who have conditions that make them likely to have a medical emergency. This includes people who have a serious illness such as severe heart disease, cancer that has spread, or advanced dementia. It also includes people who are very frail—that is, they are weak, walk slowly, are less and less active, say that they feel exhausted, and/or may be losing weight without meaning to.
Filling out a POLST form is always voluntary. Some nursing homes and assisted-living facilities include the POLST form in their admission papers, but the person being admitted does not have to fill them out.
What does a POLST form do?
A POLST form turns the person’s wishes into medical orders. A POLST form makes it more likely for a person to get the care and treatment they prefer.
For example, they could say, “I want to go to the hospital” or “I want to stay in my home.” They could say, “I want to receive these medical treatments, but not those ones.” POLST forms cover treatments such as artificial feeding, CPR, antibiotics, and other areas of care.
What is the difference between a POLST form and an advance directive?
Advance directives such as a living will and power of attorney are legal documents. They may be appropriate for all adults over the age of 18.
A POLST form is a medical order that requires health-care providers to give a person specific treatments in a medical emergency. Experts recommend that a person only get a POLST form filled out when they have become very sick or very frail, no matter their age.2
Usually a person will have a POLST in addition to, not instead of, other advance directives. A person with both POLST and advance directives should make sure that all these documents give the same instructions, so that there is no confusion or conflict about care.
What is the difference between a POLST form and a DNR (Do Not Resuscitate) order?
A POLST form is a general form that gives directions for many kinds of medical emergencies. For example, a person might want to fill one out if they are going into surgery that might leave them in a coma or in severe pain. It covers CPR and artificial breathing devices, but it also covers things such as pain medications, food, and whether the person wants to be moved to a hospital.
A DNR order only takes effect when a person has been found unconscious and with no pulse. It tells medical personnel whether to try to bring them back to life. In addition, a DNR order only covers CPR.
Can a POLST form be changed or voided?
Yes. To change any part of a POLST form, the person needs to make an appointment with their doctor or other health care provider. The provider will fill out and sign the new POLST.
To make a POLST form invalid, the person can draw a line across sections A through D of the form and write VOID on it. They then sign and date the line they have drawn, and the form is no longer valid.3 The person should always tell their doctor immediately that they have voided their POLST, so it can be taken out of their medical records.
Related information
Advance directives
Creating legal documents
Decisions related to aging and the end of life
Living wills
Overview of legal documents
Overview of health care documents
End notes
1 National POLST Maps. POLST.org.
2Advance Directives. National POLST.
3Your POLST. National POLST.
