Important Notice: In Oregon, POLST forms can be completed virtually or by phone.

To help enable POLST completion and submission to the Oregon POLST Registry during the COVID-19 pandemic, the following established standards facilitate virtual POLST form completion:

1. Verbal Orders (following institutional verbal order procedures) are valid and accepted by both EMS and the Registry. 2. The Patient or Surrogate Signature is not required on the Oregon POLST form. It is necessary to indicate with whom the POLST form was discussed (Section C). 3. Photocopies of POLST Forms on white paper are valid. 4. Health care professionals can download and print blank POLST formsmore details below.

FAQs by Health Care Professionals

Essential Information for HCPs

Where can I see Laws and Regulations related to POLST Use in Oregon?

To find Laws and Regulations related to POLST Use in Oregon, click >>HERE<<.

What is POLST?

Portable Orders for Life-Sustaining Treatment – The POLST form is a medical order set intended for patients with advanced illness or frailty, though accurate predictions cannot be made but death is likely in the foreseeable future. Note: Health care professionals are advised against the use of POLST in those individuals with stable disabilities who do not have a serious illness that is in the advanced stages. (See Guidelines on POLST Use for Persons with Significant Disabilities who are Now Near the End of Life.)

The POLST form transforms a patient’s treatment plan and goals of care into a medical order. Emergency medical responders and emergency medicine health care professionals follow these orders, unless there is new information presented by a patient or their legal decision-maker.

The POLST process encourages shared, informed medical decision-making leading to a set of portable medical orders that respects the patient’s goals for care concerning the use of cardiopulmonary resuscitation (CPR) and other medical interventions, and is applicable across health care settings. POLST orders should be reviewed and revised when the patient’s wishes or health status changes.

Is POLST required?

No. Completion of POLST forms should never be mandatory. Facilities may have policies requiring certain patients be offered the opportunity to have the conversation and complete one, but completion of a POLST form should always be voluntary. (Refer to DHS Administrative Alerts).

There may be value in the process of having a POLST conversation, even if a POLST form is not completed as a result of the conversation. The POLST process allows patients to have a better awareness of their options for treatment going forward and health care professionals to better understand their patient’s goals of care.

How can I order POLST forms?

POLST forms may be ordered only by health care professionals from medical institutions with an authorized signer of: MD, DO, NP, PA or ND, including hospitals, clinics, hospices, memory care units and SNFs.

POLST forms can be requested by using the order form in our Resources section found by clicking >>HERE<<.

Who is qualified to assist with POLST completion?

Health care professionals and social workers who are qualified to have end-of-life conversations can assist patients and/or their health surrogates to complete POLST forms.

Only an MD, DO, NP, PA or ND are able to sign a POLST form to make it valid. Read more from our Health Care Professional Regulations

Who is required to follow the medical orders in a POLST?

EMS, ED and long-term care facility personnel are required to follow the signed medical orders within a POLST until or unless they have information to the contrary.

Read more at Laws and Regulations related to POLST Use in Oregon.

When should I offer a patient a POLST form?

POLST forms should be offered to patients with advanced illness or who are older and frail and may or may not want all forms of medical treatment. Read the Oregon Medical Board Report article: Appropriate Use of the Oregon POLST Form.

Note: Health care professionals are advised against the use of POLST in those individuals with stable disabilities who do not have a serious progressive illness that is in the advanced stages.

Who completes and signs the POLST form?

The POLST form is a medical order and must be signed by the MD/DO/NP/PA/ND to be valid. Patients or their legal surrogate decision maker should be encouraged to sign, but the form is legally valid without their signature. Read more from our Health Care Professional Regulations

How do I submit a paper POLST form to the Registry?

It is the legal responsibility of the health care professional who completes the POLST form or their designee to submit a copy to the Oregon POLST Registry. Follow the Directions for Health Care Professionals found on the back of the POLST form.

The only exception is when a patient chooses not to have it submitted. The checkbox in Section D must be checked documenting that the patient does not want to have a POLST submitted to the Registry.

How do I void a POLST form?

A patient with capacity, or the legal decision maker of a patient without capacity, can void the form and request alternative treatment. If the patient no longer wishes to have POLST orders, the form should be voided.

Note: If a new form is completed, the Registry automatically archives the older form upon receipt of the new form.

  • For facilities using a paper form, draw a line through sections A through E and write “VOID” in large letters if POLST is replaced or becomes invalid, and send a copy of the voided form to the Oregon POLST Registry.

  • If included in an electronic medical record, follow voiding procedures of facility/community, and send a copy of the voided form to the Oregon POLST Registry.
When should I update a patient's POLST form?

POLST forms should be reviewed periodically and updated if:

  • The patient is transferred from one care setting or care level to another (including upon admission or at discharge), or
  • There is a substantial change in the patient’s health status.
Why is the Spanish version of POLST not a valid form?

The POLST form is read by emergency medical personnel, nurses, and physicians who may read and speak only English. For POLST Forms to be portable, they must be in English. A Spanish form is available to help explain these orders to Spanish speaking/reading persons, but the only form that is valid for use in the field is the English version.

A Spanish “sample” version of the current POLST for educational purposes may be downloaded by clicking >>HERE<<.

When should an interpreter assist in POLST completion?

Health care interpreter services should be used when the patient and/or family/surrogate has limited English proficiency. The signed version of the POLST form must be completed in English, so emergency medical personnel can understand and follow these medical orders.

A Spanish version of the Oregon POLST form is available for educational purposes only. An educational brochure for patients explaining POLST and educational videos in Spanish are available at our webpage: Español.

Can the POLST be used in place of the Advance Directive?

No. The POLST is a medical order set for EMS and other health care professionals to guide treatment in a crisis. The Advance Directive is a legal document to: 1) Share an adult’s values and goals regarding care treatment in future states of health and 2) Name a person to serve as their health care representative. Read more by clicking HERE.

Can a health care surrogate/representative be appointed on a POLST form?

No. Only an Advance Directive or the Form Appointing a Health Care Representative may be used to appoint a health surrogate in Oregon.

How should POLST be used for patients with significant disabilities?

Refer to the current Guidelines on POLST Use for Persons with Significant Disabilities who are Now Near the End of Life – POLST for DD 2020 rev. v7.2 08.03.2020.

Note: Health care professionals are advised against the use of POLST in those individuals with stable disabilities who do not have a serious illness that is in the advanced stages. See the Oregon DHS Office of Developmental Disabilities Services fact sheet on POLST use.

Where can I find additional resources for health care professionals?

Additional resources for health care professionals are also available on our Resources webpage. Resources include downloadable educational materials, presentations, research publications and Department of Human Services Provider Alerts, including other Laws and Regulations related to POLST use in Oregon.

Can’t find what you are looking for?  Visit our Resources page.

Virtual & Verbal Orders – Explained

OAR 333-270-0030(19)

2019 Oregon POLST form front page only

Current POLST for Download by Health Care Professionals Only

During the Covid-19 Pandemic, the Oregon POLST Program has enabled health care professionals to print a PDF of the POLST form to enhance access for those using paper forms at virtual visits.

All POLST Quality Standards still apply (See OAR 333-270).

The POLST form must be signed by an MD, DO, NP, PA, or ND licensed in Oregon (or employed by the VA). Documentation of who participated in the conversation and details outlining the patient’s goals should be included in the medical record.

  • The POLST form layout and text must not be altered.
  • Copy or print forms onto:
    • Size: 8.5 x 11 inches
    • Paper Color: Bright White
    • Paper Weight: 65 lb. (optional)
    • Material: Cardstock Paper (optional)

By downloading this medical order form, I agree to the above provisions. – Click here to access the current Oregon POLST Form to download and print.