Physician Orders for Life Sustaining Treatment (POLST)

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Physician Orders for Life Sustaining Treatment (POLST)

The Department of Health (DOH) Office of Emergency Medical Services & Trauma System (OEMSTS) in conjunction with the Washington State Medical Association (WSMA) has implemented a new form, which will allow individuals to summarize their wishes regarding end of life treatment.

The new Physician Orders for Life Sustaining Treatment (POLST) form is a “portable” physician order form that describes the patient’s code directions. 

·       It is intended to go with the patient from one health care setting to another. 

·       It represents a way of summarizing wishes of an individual regarding life-sustaining treatment identified in an advanced directive such as a Healthcare Directive or Durable Power of Attorney for Health care and includes the following:

1.     Patient wishes for resuscitation

2.     Medical interventions

3.     Antibiotics

4.     Artificial feedings

The form is available to physicians free of cost from WSMA using the order form found on the link below.  

Previously completed and signed EMS-No CPR forms will continue to be honored by prehospital EMS personnel.

POLST Materials Available

• Curriculum and Protocols for EMS Providers

  • POLST Power Point Presentation – Facilities

  • POLST Power Point Presentation – Pre-Hospital

• Fact Sheet

• Physicians Order Form

• Information Resource List

• POLST Form and Information

Files contained on this page require you to obtain the Free Adobe Acrobat Reader.  Documents posted in .pdf version on the Department of Health Web site will be made available in an alternative format on request to users who are unable to download or view .pdf files on the Web. To request an alternative format, contact the Subsite Developer.

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Office of Emergency Medical Services and Trauma System
P.O. Box 47853,
Olympia, Washington, 98504-7853
Phone: (360) 236-2828
(Fax: 360) 236-2829 or 236-2830

Last Update : 04/14/2006 09:36 AM
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