POLST Form

Unlike a general advance directive, a POLST is a signed physician's order that healthcare providers are legally required to follow immediately in a medical emergency. It helps healthcare providers follow the patient’s wishes during a medical crisis.

The form translates a patient's end-of-life care preferences into actionable clinical instructions. It typically covers decisions about resuscitation, mechanical ventilation, artificial nutrition, and hospitalization. Because it functions as a medical order rather than a planning document, it carries immediate legal and clinical weight across care settings.

POLST forms are designed primarily for individuals with serious illness, advanced frailty, or a limited life expectancy—typically those for whom a healthcare provider would not be surprised if they died within a year. They are not intended for healthy adults as a general planning tool.

How a POLST form works

A POLST form is completed through a conversation between a patient (or their authorized representative) and a licensed healthcare provider. The provider documents the patient's treatment preferences and signs the form, giving it the force of a medical order.

The completed form accompanies the patient across care settings, from home to hospital to nursing facility, and is intended to be immediately accessible to emergency responders and clinical staff. In most states, emergency medical personnel are required to honor a valid POLST form.

The form typically addresses three core decision areas:

• Cardiopulmonary resuscitation (CPR). Whether to attempt resuscitation if the patient's heart stops
• Medical interventions. The level of treatment desired, ranging from comfort-focused care only to full hospitalization and aggressive intervention
• Artificial nutrition. Whether to use feeding tubes or IV fluids if the patient cannot eat or drink

Once signed, the form should be kept in an accessible location, such as on a refrigerator door at home or in a medical chart at a care facility.

Why a POLST form matters

For patients with serious illness, a POLST form ensures that specific, immediate treatment preferences are communicated and legally enforceable. Without it, emergency responders default to providing all available life-sustaining treatment, regardless of the patient's wishes.

The form reduces the risk of unwanted medical interventions at the end of life. It also spares family members and caregivers the need to make urgent, high-stakes decisions under pressure without clear guidance.

Because a POLST is a physician's order, it carries more immediate authority in an emergency than a standard advance directive or living will. Healthcare providers who encounter a valid POLST are expected to follow it without delay.

Common uses and examples of a POLST form

POLST forms are used across a range of serious medical situations. Common scenarios include:

• A patient with terminal cancer who has decided against aggressive resuscitation completes a POLST with their oncologist specifying "Do Not Attempt Resuscitation" (DNAR) and comfort-focused care only, a choice strongly associated with hospice enrollment at the end of life.
• An elderly nursing home resident with advanced dementia has a POLST completed by their healthcare proxy and attending physician, directing staff to avoid hospitalization and focus on pain management.
• A patient with end-stage heart failure uses a POLST to document that they want limited medical interventions, such as treatment for infections, but do not want mechanical ventilation or CPR.
• A homebound patient receiving hospice care keeps a signed POLST on their refrigerator so that emergency responders can locate and honor it immediately if called.

Key characteristics of a POLST form

Several features distinguish a POLST from other end-of-life planning documents.

• It is a medical order, not just a directive. A POLST carries the same legal authority as any other physician's order and must be followed by healthcare providers.
• It is condition-specific. POLST forms are designed for individuals with serious, life-limiting illness, not for general advance care planning by healthy adults.
• It is portable. The form is intended to move with the patient across all care settings, including home, hospital, and long-term care facilities.
• It can be revoked or updated. A patient with decision-making capacity can revoke or change a POLST at any time by informing their provider.
• It varies by state. The form's name, format, and legal requirements differ across states; 43 states and Washington, D.C., have codified their POLST programs into state law. Some states use alternative names such as MOLST (Medical Orders for Life-Sustaining Treatment), MOST (Medical Orders for Scope of Treatment), or POLST Paradigm.

POLST form vs. advance directive

A POLST form and an advance directive, such as a living will, are related but serve different functions. An advance directive is a planning document that expresses general healthcare preferences and appoints a healthcare agent. Although approximately one in three U.S. adults has completed one, it takes effect only when the person loses decision-making capacity.

A POLST, by contrast, is a physician's order based on a patient's current medical condition. It is specific, immediately actionable, and intended for individuals who are already seriously ill. While an advance directive guides future decision-making, a POLST translates current wishes into standing medical orders.

The two documents can, and often should, coexist; patients with POLST are 3 times more likely to have orders that match their preferences, and research shows that those who engage in advance care planning are less likely to die in the hospital and more likely to enroll in hospice. An advance directive may inform the conversations that lead to a POLST, but they are not interchangeable.

Considerations and limitations

A POLST form is only valid when signed by a licensed healthcare provider. A patient or family member cannot complete one independently; it requires a clinical conversation and a provider's signature.

Because POLST requirements vary significantly by state, a form completed in one state may not be automatically honored in another, though a December 2025 interoperability milestone now makes validated Oregon POLST forms accessible nationwide through participating EHR networks. Patients who travel frequently or split time between states should confirm whether their form meets the requirements of each relevant jurisdiction.

A POLST does not replace a comprehensive advance care plan. Individuals should also consider completing a living will and designating a healthcare power of attorney to address a broader range of medical scenarios, particularly those that may arise before a terminal diagnosis.

Related terms and next steps

Understanding a POLST form is one part of a broader approach to end-of-life planning. Related documents and concepts include.

• Advance healthcare directive. A written legal document that outlines general medical care preferences and appoints a healthcare agent, typically completed by any adult as part of estate planning
• Living will. A component of an advance directive that specifies which medical treatments a person does or does not want if they become incapacitated
• Healthcare power of attorney. Designates a trusted person to make medical decisions on a patient's behalf if they are unable to do so
• Do Not Resuscitate (DNR) order. A specific physician's order directing that CPR not be attempted, often incorporated into a POLST but can also exist as a standalone order

For individuals who are not yet seriously ill, completing an advance healthcare directive, including a living will and medical power of attorney, is the appropriate starting point for documenting end-of-life care preferences. LegalZoom offers advance healthcare directive documents that can help adults of any age put these wishes in writing.

FAQs about POLST forms

What is the difference between a POLST form and a DNR order?

A DNR is a single, narrow order directing that CPR not be attempted; a POLST is a broader medical order that encompasses CPR decisions, as well as directives regarding mechanical ventilation, artificial nutrition, and the overall level of medical intervention desired. A DNR can exist as a standalone order, but a POLST effectively subsumes it within a more comprehensive set of standing clinical instructions.

How does a patient or family member obtain a POLST form?

A POLST cannot be obtained or completed independently; it must be initiated through a conversation with a licensed healthcare provider who then signs the form to give it legal force as a medical order. The appropriate starting point is a direct conversation with the patient's primary care provider, oncologist, or the clinical team managing their serious illness.

Is a POLST form legally valid if a patient is transferred to a different state?

Because POLST requirements are established at the state level, a form completed in one state is not automatically recognized as a valid medical order in another. The receiving state's legal framework governs whether and how the document will be honored. Patients who divide their time between states or anticipate interstate transfers should ask their provider whether a separate form is required in each relevant jurisdiction and confirm the requirements directly with the applicable state program.

Can a POLST form be changed after it has been signed?

Yes, a patient who retains decision-making capacity can revoke or update a POLST at any time by communicating that decision to their healthcare provider, who then completes a revised form. The prior version should be voided and destroyed to prevent conflicting orders from circulating across care settings.

Does having a POLST form mean a patient has given up on treatment?

A POLST does not default to comfort-only care. Rather, it documents whatever level of treatment the patient actually wants, which can range from full aggressive intervention to comfort-focused care only, depending on the individual's preferences and goals. The form's purpose is to ensure that emergency care aligns with the patient's choices, not to categorically limit treatment.