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 polst@ohsu.edu.

2011, 2014, 2018 and 2019 versions of the Oregon POLST form are currently being accepted for submission by the Oregon POLST Registry.

Need a Spanish POLST form?

The English version is the only form that is valid to be used in the field.

However, a Spanish “sample” form is available to help explain these orders to Spanish speaking persons and is for educational purposes only. Because the POLST form is read by emergency medical personnel and other health care professionals who may read only English, the form must be completed in English.

Visit our Español page for the Spanish “sample” version of the current POLST for educational purposes or to find more Spanish resources.

Request POLST Materials

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