Ordering Oregon POLST® Forms and Materials
Please note: Only health care professionals and medical organizations may order POLST forms. We distribute to health care professional organizations with the goal of assuring that POLST is used in the appropriate patient population. Such medical professionals are considered as personnel of medical institutions with an authorized signer of: MD, DO, NP, PA or ND, including hospitals, clinics, hospices, memory care units and SNFs.
Independent living communities, assisted living facilities and adult foster care homes do not qualify to order POLST forms, but should refer residents to their primary care professionals for a POLST conversation.
If you are a patient who wants a POLST, you should schedule an appointment with your medical provider/doctor to discuss:
- Your current health conditions, and
- If these medical orders are appropriate for you.
The POLST is not a substitute for the Advance Directive. Learn more about the Oregon Advance Directive here.
2019 Oregon POLST® Form
The 2019 Oregon POLST form (version 13) was made effective on January 2, 2019 and is the current version. The Oregon POLST Coalition requests all Oregon health systems to implement the use of the 2019 form when creating new orders.
Entities interested in printing their own forms should contact the Oregon POLST Program at firstname.lastname@example.org.
2011, 2014, 2018 and 2019 versions of the Oregon POLST form are currently being accepted for submission by the Oregon POLST Registry.
Need a POLST form in another language?
Note: A signed POLST must be in English, so emergency personnel can read and follow the orders.
However, the front page of the Oregon POLST form has been translated into 14 other languages for educational purposes only. The full list of these translated “sample” versions can be found under Educational Tools on our Resources page.
Visit our Español page to find more Spanish POLST resources, including videos and patient stories.
Request POLST Materials
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