THE POLST MODEL

Using the POLST Model encourages communication between healthcare professionals and patients and caregivers, allowing people to make more informed decisions about medical treatment based on goals and values.

THE POLST MODEL

The POLST (Practitioner Orders for Life - Sustaining Treatment) Model has two equally important parts.

  • FIRST - A conversation between an individual patient and/or someone close to that person who might help make medical decisions for them along with a clinician on the individual’s medical care team.
  • SECOND – A form telling first responders and emergency healthcare providers what to do if that individual experiences a critical medical emergency.

Using the POLST Model encourages communication between healthcare professionals and patients and caregivers , allowing people to make more informed decisions about medical treatment based on goals and values.

The POLST form documents these decisions in a clear manner resulting in a patient’s wishes being honored across all settings of care.

A POLST form is voluntary and is never required. If a person does not have a POLST form, they will receive all medically indicated treatment in an attempt to maintain life.

The goal of the POLST Model is to maximize every patient's control of their medical care by helping them establish a care plan that aligns with their own treatment wishes given what is medically realistic. Then, the POLST form documents these wishes in a uniform, secure and retrievable medical order that can be used to direct medical care in a variety of settings out in their community.

USING THE POLST MODEL APPROPRIATELY

The POLST decision-making process and resulting medical orders are intended for people of any age who are at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty.

FAQS/GUIDANCE

For guidance on FEQUENTLY ASKED QUESTIONS about the POLST Model click here.

For FAQS/GUIDANCE Click here

POLST: Doing It Better

“Doing It Better” provides a clear overview of the POLST Model. It is an educational tool for healthcare professionals and the public that describes POLST, clarifies which individuals should be offered a conversation about the form, emphasizes best practices for POLST and corrects some common misconceptions.

Click here to watch video

Download the POLST Form

The POLST form is available in English and Spanish. To ensure emergency personnel can understand and follow the orders, it is recommended that the POLST form be documented in English. The Spanish version of the form is helpful for educational purposes.

POLST Form (English)
POLST Form (Spanish)

Download the POLST Form

The POLST form is available in English and several other languages. To ensure emergency personnel can understand and follow the orders, it is recommended that the POLST form be documented, signed and displayed in English. The non-English versions of the form have BOTH the English and the non-English translation on a double-sided 2-page form. The non-English sides are for educational/discussion purposes only.

POLST Form (English)
POLST Form (Spanish)
POLST Form (French)
POLST From (Polish)
POLST Form (Hindi)
POLST Form (Chinese-Simplified)
POLST Form (Arabic)
POLST Form (Chinese-Traditional)
POLST Form (Korean)