What Patients and Their Surrogates Need to Know.
On this page you will find:
Answers to common questions (FAQs)
A Sample POLST Form to read and print
Short videos without complicated medical language
A factsheet in several languages for someone new to POLST
14 translated versions of the front page of the Oregon POLST form
Stories about people like you who are a patient or who take care of someone else
POLST: When is the Right Time?
This 3-minute video shows us when it might be the right time to create a POLST.
It shows us changes in Betty’s health. First she has an advance directive, when she is healthy. But later when she becomes seriously ill, she completes a POLST with her doctor*.
* “Doctor” refers to person, who can sign a POLST form. The POLST form needs the signature of a physician (MD or DO), nurse practitioner (NP), physician assistant (PA) or naturopathic doctor (ND).
Answers to Frequently Asked Questions
Videos & Stories about POLST
What is a POLST?
It is a medical form that you may use to turn your wishes for treatment near the end of life into medical orders. Emergency medical personnel will know what you do and do not want done to you during a medical emergency.
POLST (Portable Orders for Life-Sustaining Treatment) is a way to have and document an important talk with your doctor* about what you would or would not want when you can no longer speak for yourself.
*Physician or Nurse Practitioner or Physician Assistant
What does a POLST do?
- It guides treatment decisions if you later lose the ability to speak for yourself.
It gives you more control over the treatments you do or do not want to receive in a medical emergency.
- It does not replace an advance directive.
Should I have a POLST?
Only if you have a serious illness, such as advanced heart disease, advanced lung disease or cancer that has spread. Or, if you are older and frail and do not want all available medical treatments (like going to the ICU – Intensive Care Unit).
A doctor can help a person decide if they should have a POLST. This decision is based on a person’s current health condition.
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.
Is the POLST the same as the Advance Directive?
No. These forms have different purposes and do different things. Read more by clicking HERE.
How can I get a POLST?
By having a talk with your doctor about what type of medical care you want near the end of your life.
If you are diagnosed with a serious illness or frailty, you can ask about POLST or your doctor may tell you about it. The talk should include:
- What your medical diagnosis is (what you have)
- What is likely to happen to you in the future (how the illness or disease will affect you)
- What your treatment options are (including the risks and benefits of each option)
- What your wishes are for treatments—What do you want? What do you not want?
- This is a good time to talk about hard topics that you would like to better understand. This includes any questions you or your family have about care near the end of life.
How do I talk about POLST with my doctor?
Remember the ABCs of talking with your doctor.
Ask Questions. If you do not understand something, ask. It is important that you understand what is happening to you and what each treatment option means for you.
Be Honest. Your doctor wants to know what treatments you do or do not want.
Communicate with Your Loved Ones. Share your decisions with your loved ones and friends so they can help advocate for you when you cannot speak for yourself.
Must I have a POLST?
No. Filling out a POLST form is completely up to you. It is your choice. It is always voluntary and can be changed any time at your request.
You do not have to complete a POLST at a Medicare Wellness Visit.
POLST is not for everyone. For example, many people in their 60s are too healthy to need a POLST form. If something suddenly happened, many healthy older adults would want everything done while more was learned about what was wrong and their chances of recovery. Healthy people should have an advance directive. Later, if you become sicker or more frail, you or your surrogate/health care decision-maker can complete a POLST form to turn your treatment wishes into action with medical orders.
Who completes and signs the POLST?
If you are able to speak for yourself, you can complete the POLST form with your doctor. If you are not able to speak for yourself, your surrogate/health care decision-maker can complete a POLST form on your behalf. Because the POLST form contains medical orders, it must be signed by a physician (MD or DO), nurse practitioner (NP), physician assistant (PA) or naturopathic doctor (ND).
How does my POLST get entered into the POLST Registry?
It is the responsibility of the health care professional who completes the POLST form to submit it to the Oregon POLST Registry. They do this by following the directions for health care professionals found on the back of the form.
A POLST form is sent to the POLST Registry, except when a patient chooses not to have it sent. The checkbox in Section D must be checked to not have a POLST sent to the Registry.
Who can speak for me when I cannot speak for myself?
If you are not able to speak or communicate your wishes, someone else may be able to complete a POLST for you with your doctor. An advance directive is the legal document that allows you to choose someone to speak for you when you cannot. You must use an advance directive to document who will be your surrogate/health care decision-maker.
How do I cancel or void my POLST?
A patient with legal capacity, or the legal decision maker of a patient without capacity, can void the form and request other forms of treatment.
- On the signed paper POLST form, draw a line through sections A through E and write “VOID” in large letters. Send a copy of this voided form to the Oregon POLST Registry. They will then void it from the Registry.
- It is important to contact the patient’s health system, clinic and/or facility also to instruct them to void or remove this copy of the POLST from their system’s records.
How does a new POLST replace my older POLST?
When the Oregon POLST Registry receives a new POLST, they cancel or “void” the older POLST that is on file. The Registry then mails a letter to the patient (using the address provided on the new POLST) to confirm that a new POLST has been registered and that the information is correct.
Patient, Family & Surrogate Stories
Family Members Should Not Be Required to Sign a POLST for Their Loved One - A Story
Choosing Full Treatment when You Hope for More Time - A Story
A Factsheet for Someone New to POLST
A Sample POLST Form to Read & Print
Click on the image to the left or click the button below to see the current (2023) sample POLST form.
You may download and print this sample form.
This form is to help you prepare for an appointment with your health care professional.
Translated Versions of the 2023 Oregon POLST Form
Download & Print for Educational Purposes Only
These translated versions of the Oregon POLST form are not valid forms. They are for educational purposes only.
Translated versions are offered to help explain POLST during talks between health care professionals, their patients and health surrogates.
A signed POLST must be in English, so emergency personnel can read and follow the orders.
Give to Oregon POLST
The Oregon POLST Program does not accept gifts from health care industry sources.
Your gift protects your independent voice.