What is a POLST form? Who needs one and how to get it

A POLST form is a medical order — signed by a physician — that tells emergency responders and healthcare providers exactly what life-sustaining interventions a patient does and does not want. It is not a document you fill out on your own. It is a clinical order that travels with the patient across care settings and takes effect immediately.

POLST is designed for a specific group of people: those who are seriously ill, significantly frail, or near the end of life. If you are a healthy adult planning for the future, what you need is an advance directive. A POLST becomes relevant when serious illness is not hypothetical anymore.

POLST vs. advance directive: the key difference

The confusion between these two documents is extremely common, and understanding the difference matters a great deal in a medical emergency.

An advance directive (living will and healthcare power of attorney) is a legal document you create yourself. It records your values and general wishes about future medical care and names someone to make decisions on your behalf. It guides decision-making but is not itself a medical order. Every adult should have one — healthy or not.

A POLST form is a physician's order that translates your wishes into specific, immediately actionable clinical instructions. Emergency responders and hospital staff treat it exactly like any other physician's order. They act on it without waiting for family consultation or physician review.

Think of it this way: your advance directive says "I would not want to be kept alive on a ventilator indefinitely with no meaningful chance of recovery." Your POLST turns that value into a concrete instruction: "Level of intervention: comfort-focused. CPR: do not attempt."

For people with serious illness, both documents working together provide the most complete protection. Your advance directive informs what goes into the POLST; the POLST is what emergency responders act on.

What a POLST covers

A standard POLST form addresses three main areas of medical decision-making.

CPR preferences

The first section specifies whether CPR should be attempted if the patient's heart stops or they stop breathing. Options are typically "Attempt Resuscitation/CPR" or "Do Not Attempt Resuscitation." This section functions identically to a standalone DNR order. If you have a POLST that marks "do not attempt resuscitation," you effectively have a DNR within it — a separate DNR document may not be necessary. Confirm with your physician which your state and care setting require.

Level of medical intervention

This section addresses what happens beyond cardiac arrest — how aggressively the patient wants to be treated when seriously ill but their heart is still beating. Most POLST forms offer three options:

Full treatment means every medically appropriate intervention, including ICU admission, intubation, and mechanical ventilation. Appropriate for patients who want every possible measure taken.

Selective treatment (limited interventions) means medical treatment to relieve pain and manage reversible conditions, while avoiding more burdensome measures like prolonged ICU care or mechanical ventilation. Hospital admission may be appropriate for short-term stabilization.

Comfort-focused treatment means the goal is maximizing comfort. Interventions are used only to relieve pain and symptoms. Transfer to a hospital only if comfort cannot be maintained in the current setting. This option aligns closely with hospice care.

Artificial nutrition

The third section addresses whether nutrition delivered artificially through a feeding tube should be offered if the patient cannot eat. Options typically include offering a trial period of artificial nutrition, not offering it, or deferring to clinical judgment based on the situation.

Who should have a POLST

POLST forms are intended for patients whose current health status makes medical intervention decisions immediate and urgent — not hypothetical. The form is generally appropriate for:

• People with advanced cancer, advanced heart failure, advanced COPD, or other serious diagnoses
• People with advanced dementia
• Elderly patients with significant frailty and a life expectancy estimated at one to two years or less
• People enrolled in hospice or receiving palliative care
• Patients in long-term care or skilled nursing facilities

If none of those descriptions apply to you right now, a POLST is not the right document for your current situation. That does not mean you should skip end-of-life planning — it means your advance directive is the right tool at this stage. You can revisit POLST later if your health situation changes.

The bright-pink paper form

If you have seen a brightly colored form — often pink or yellow — stapled to the front of a medical chart or posted on a refrigerator, that was likely a POLST form.

The distinctive coloring is intentional. Emergency responders have seconds to assess a patient's wishes in a crisis. A standard white document buried in a stack of papers will not be found in time. The bright color is a design choice that makes the form immediately visible and signals to any healthcare provider exactly what it is.

Most states require POLST forms to be printed on a specific color of paper in a specific state-approved format. A form that does not match the state's required format may not be honored by local emergency responders.

How a POLST travels with the patient

One of POLST's defining features is portability. When a patient moves from a nursing facility to a hospital, from home to a hospice, or arrives via ambulance, the POLST should travel with them and be honored in each new setting.

This means:

• At home: Keep the POLST visible — on the refrigerator is the standard recommendation, as emergency responders are trained to look there. A bedside location also works if you have home health staff.
• In a care facility: The POLST should be at the front of the medical chart, prominently accessible.
• During transport: The POLST should accompany the patient in transit. Family or care staff transferring a patient should hand the form directly to the receiving team.

Several states have established POLST registries — electronic databases where the form is stored and can be retrieved by emergency responders and hospitals. If your state has a registry, ask your physician about registering your form. A digital backup substantially reduces the risk that your wishes are unknown in an emergency.

How to get a POLST form

You cannot complete a POLST on your own. The process requires a conversation with a licensed healthcare provider.

Step one: Have a goals-of-care conversation with your physician, palliative care team, or hospice team. This should be a substantive discussion, not a form-signing exercise. Your provider should explain what each option means in the context of your specific medical situation. What does "full treatment" realistically look like for someone with your diagnosis? What is the likely outcome of CPR given your condition? These are the questions the conversation should answer.

Step two: Complete the form together. Your provider walks through each section with you — or with your healthcare agent if you lack capacity. Both you and your provider sign the form. Some states also require a witness signature.

Step three: Ensure the form meets your state's format requirements. Most states require a specific approved form and paper color. Your provider's office will typically have the correct forms on hand.

Step four: Place the form where it will be found. At home, this means the refrigerator or bedside. In a care facility, it goes to the front of your chart.

When to update a POLST

A POLST should reflect your current wishes, not a decision made months or years ago. Update it after:

• Any significant change in health status or new serious diagnosis
• A hospitalization
• A transition between care settings (for example, home to skilled nursing facility)
• Any change in your goals of care

To revoke or update a POLST: inform your care team verbally, cross out the old form and write "VOID" across it, and complete a new form with your provider. Distribute the updated form to everyone who has the old one.

POLST and hospice

Most patients enrolled in hospice have a POLST that marks comfort-focused treatment and do not attempt resuscitation. This alignment makes sense — hospice care is organized around comfort rather than curative intervention, and the POLST's instructions reinforce that approach.

Having a POLST is not a requirement for enrolling in hospice, and electing hospice does not automatically create a POLST. They are separate decisions, but they are typically addressed together during the hospice intake conversation. Your hospice team will review your existing POLST — or help you create one if you do not have it — as part of establishing your plan of care.

What happens if paramedics cannot find the POLST

If emergency responders arrive and cannot locate a valid POLST within seconds, they are generally required by law to attempt resuscitation. This is not a failure — it is the protocol designed to protect patients when documentation is absent or ambiguous.

The time to solve this problem is before an emergency. If you or a loved one has a POLST, make sure it is immediately visible and accessible. If your state has a POLST registry, registration provides a critical backup. And make sure your family and anyone else who might call 911 on your behalf knows where the form is and what it says.

Frequently asked questions

Do I need a POLST if I already have an advance directive? Not necessarily, and probably not if you are currently healthy. An advance directive handles the planning function well for most adults. A POLST becomes relevant when you have a serious illness and want your specific treatment preferences converted into a medical order that emergency responders can act on immediately. If your physician is not recommending a POLST, your advance directive is likely sufficient for now.

Can a POLST override my advance directive? In practice, the POLST governs in emergency situations because it is a medical order that emergency responders act on directly. Your advance directive may be a multi-page legal document that is not readily accessible or reviewable in a crisis. This is why the POLST should accurately reflect the intentions expressed in your advance directive. If you update your advance directive but not your POLST, contact your physician to align them.

Who actually signs the POLST form? Both the patient (or their legally authorized healthcare agent, if the patient lacks decision-making capacity) and a licensed healthcare provider — typically a physician, nurse practitioner, or physician assistant, depending on state law. Unlike an advance directive, no witnesses or notary are required in most states. A POLST signed only by the patient has no legal effect as a medical order.

What if I am transferred to a new hospital and they do not honor my POLST? POLST forms are intended to be honored across care settings. If a receiving facility raises questions, ask to speak with the attending physician, a palliative care team member, or the hospital patient advocate. A valid, state-compliant POLST is a medical order that healthcare providers are professionally and legally obligated to follow.

Is a POLST the same as a DNR? A POLST includes a CPR/DNR section, but it is broader than a standalone DNR. A DNR covers only the CPR decision. A POLST also addresses level of medical intervention and artificial nutrition. If you have a POLST that marks "do not attempt resuscitation," you have effectively incorporated a DNR within it. For a deeper look at what a DNR covers on its own, see what is a DNR.

What Passings Can Help With

Navigating end-of-life medical decisions is hard enough without also worrying about whether the right documents are in the right places. Passings helps you keep track of where your POLST is stored, who has a copy, and whether your medical wishes are current — so your family and care team can focus on being present rather than searching for paperwork.

This article is informational only and is not medical or legal advice. Please work with your physician and a qualified attorney to determine which documents are right for your situation. For a full picture of what belongs in your end-of-life plan, the end-of-life documents checklist is a useful starting point.

Disclaimer — For informational purposes only

This article is compiled from publicly available resources and is provided solely for general informational purposes. It does not constitute and should not be relied upon as legal, financial, tax, insurance, medical, psychological, or other professional advice. Passings is a planning and organizational platform, not a licensed advisory service, and no attorney-client, financial advisor-client, or other professional relationship is created by reading this content.

Laws, regulations, financial products, and professional standards vary by state and change over time. Passings makes no representations or warranties — express or implied — regarding the accuracy, completeness, timeliness, or suitability of any information contained herein. To the fullest extent permitted by applicable law, Passings disclaims all liability for any loss, damage, or harm arising from your use of or reliance on this content. Always consult a qualified, licensed professional — including an attorney, financial advisor, CPA, or licensed counselor — before making decisions specific to your situation.

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