Oregon POLST Resources for POLST Completion & Submission

One-page Summary of Changes in the 2023 POLST Form
Oregon POLST Registry's Submission Requirements & Instructions
How do I order 2023 Oregon POLST forms?

Beginning in January, new 2023 POLST forms can be ordered by hospitals, clinics, hospices, memory care units, SNFs and other facilities at https://oregonpolst.org/ordering-oregon-polst-forms-and-materials/ or look under the website’s Resources tab.

POLST Guidelines 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.

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.

Determining Statutory Appointment of Health Care Representative Without Written Appointment

ORS 127.635(2)(a-g) – Statutory appointment of health care representative without written appointment

Verbal Orders / Virtual Orders for POLST Completion & Submission

The Oregon POLST Registry will accept verbal/phone orders from MD/DO/NP/PA/ND in accordance with the submitting facilities’ verbal order policy. Verbal orders should be documented per medical practice standards. Refer to OAR 333-270-0030.

Suggested steps for Hospice & Long-Term Care

  • A designated trained staff person assists a patient or legal decision maker to complete the POLST form.
  • If the signer is not present, a verbal order for POLST is obtained from the responsible physician/nurse practitioner/physician assistant.
  • Per their institutional/organizational policy, an authorized staff person documents the verbal order (‘VORB’ or ‘VO’ or ‘TO’) with the first and last name of the authorizing physician/nurse practitioner/physician assistant along with their name and role in the signature box, the date the order was authorized in the required date field, AND LEGIBLY prints the first and last name of the authorizing professional in Section E ‘Print Signing MD/DO/NP/PA/ND Name.’ This will allow for rapid and reliable entry into the Registry.
  • Same day submission: The staff person then takes the POLST form and using a FAX cover sheet, FAXes it to the Registry, and returns the POLST form as soon as possible to the patient’s home.
  • The Registry should be sent the authenticated/signed POLST form once it is available.
POLST Guidance for Oregon's Health Care Professionals
Where can I find additional resources for health care professionals?

Additional resources for health care professionals are on our Resources webpage.

Upcoming 2023 Version

of the Oregon POLST Form

Current (2019) Oregon POLST Sample Form

Translated Versions of the Current (2019) Oregon POLST Form for Educational Purposes Only to Download & Print

These translated versions of the Oregon POLST form are not valid forms. They are for educational purposes only. Translated versions are offered to improve POLST health literacy during conversations among health care professionals, their patients and health surrogates.

A signed POLST must be in English, so emergency personnel can read and follow the orders.