POLST in California

Physician Orders for Life-Sustaining Treatment (POLST)

POLST, which stands for Physician Orders for Life-Sustaining Treatment, is a crucial document that reflects a patient’s wishes and treatment goals, particularly for those who are seriously ill or have chronic conditions. It is completed by the physician and patient, and the form is designed to be easily accessible to emergency medical teams, often kept on the refrigerator or the back of the front door



Key Aspects of POLST

  • Completion and Access: The form should be readily accessible to emergency medical personnel, caregivers, and assisted living facility staff, and it should follow the patient across different care settings, from home to emergency services and other facilities.
  • Obtaining the Form: Not all states have POLST programs in place, but the form can typically be obtained from a primary or family physician, and of course, downloaded here.

Managing Your POLST Form

Once the POLST form is completed, it should be carried if the patient goes to a facility, or if they are at home, it should be prominently displayed on the refrigerator or kept in an easily accessible location. It’s important to note that the form cannot be changed by the patient and requires a provider’s signature for any modifications.

Benefits of POLST

The POLST form is designed to provide patients with more control over the medical treatment they receive, ensuring that their wishes are respected across various healthcare settings. It helps guide discussions between patients, their families, and healthcare teams about treatment wishes in instances of serious illness.

Form for Download

POLST is a vital tool for individuals facing serious illness or frailty, allowing them to express their treatment preferences in a way that is recognized and respected across different healthcare settings. It is important to understand the purpose of the form and ensure that it accurately reflects the patient’s current medical condition and treatment goals. If you have questions, be sure to contact our volunteers to disscuss this and other end of life issues.

Download California POLST form

Download the form (pdf).

POLST in other languages

Visit California POLST website for translation information.

Contact a Volunteer

If you have questions, would like to discuss advance care planning further, or need help preparing your advance directives, please contact us.  A volunteer will follow up with you to find out how we can assist.

POLST form for download:

The POLST form is hot pink, easily viewed, usually printed on card stock, completed on both sides, and designed to help medical professionals honor the end-of-life wishes of their patients.


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