What Is a POLST Form and Who Needs One?
By CRYSTAL BAI •
The short answer: A POLST (Physician Orders for Life-Sustaining Treatment) is a physician-signed medical order for seriously ill patients that covers CPR, medical intervention level, and artificial nutrition — immediately actionable by EMS. It is distinct from an advance directive, which is a legal document for general planning. POLST is for people who are currently seriously ill; advance directives are for everyone.
What Is a POLST?
POLST stands for Physician Orders for Life-Sustaining Treatment (though the name varies by state — it is called MOST, POST, MOLST, DMOST, or LAPST in different states). It is a portable physician-signed medical order that communicates a seriously ill person's treatment preferences to emergency responders, hospitals, and care facilities. Unlike an advance directive (which is a legal document expressing wishes), a POLST is an actual medical order — immediately actionable by EMS without calling a physician.
What a POLST Covers
A POLST form typically addresses three to four core medical decisions:
- CPR (Section A): Attempt resuscitation (full code) vs. Do Not Attempt Resuscitation (DNAR/DNR)
- Medical interventions (Section B):
- Comfort measures only: Focus on relieving pain and symptoms; avoid interventions not consistent with comfort (no hospital transfer unless needed for comfort)
- Limited additional interventions: Comfort care plus specific additional treatments (IV fluids, cardiac monitoring); avoid intensive care or mechanical ventilation
- Full treatment: All medically indicated treatments including ICU and ventilator if needed
- Artificial nutrition (Section C): Long-term feeding tube, short-term feeding tube, or no feeding tube
- Signatures: Physician/NP/PA signature (required) and patient/surrogate signature
Who Needs a POLST
POLST is designed for people who are seriously ill, frail, or elderly — specifically those who:
- Have a life-limiting illness (cancer, heart failure, COPD, dementia, ALS)
- Are in a nursing home or other care facility
- Are enrolled in hospice or palliative care
- Have a realistic chance of experiencing a medical emergency in the coming year
- Have clear preferences about how aggressively they want to be treated
Generally healthy adults who are not currently seriously ill should complete an advance directive — not a POLST. A POLST without a serious illness is premature and may limit appropriate care.
How POLST Works in Emergencies
When EMS arrives at a home, nursing facility, or other location, they look for a POLST form. In most states, the POLST must be visible or readily accessible (on the refrigerator door is a common recommendation). EMS follows the orders on the POLST without requiring physician consultation. This is why the POLST is different from an advance directive — it is immediately actionable in emergencies.
POLST State Names
| State Name | Used In |
|---|---|
| POLST (Physician Orders for Life-Sustaining Treatment) | Most states |
| MOST (Medical Orders for Scope of Treatment) | North Carolina, Missouri, Kentucky |
| POST (Physician Orders for Scope of Treatment) | Tennessee, West Virginia |
| MOLST (Medical Orders for Life-Sustaining Treatment) | New York, Maryland, Michigan |
| DMOST (Durable Medical Orders for Scope of Treatment) | Virginia |
| LAPST (Louisiana Physician Orders for Scope of Treatment) | Louisiana |
How to Get a POLST
A POLST must be initiated by a licensed healthcare provider (physician, NP, or PA) in a conversation with the patient or their healthcare surrogate. Talk to your primary care physician, hospice nurse, or palliative care team. Death doulas can help you prepare for this conversation — clarifying your values and preferences so that the POLST accurately reflects your wishes. Renidy can connect you with an end-of-life professional who specializes in advance care planning conversations.
Frequently Asked Questions
Is a POLST the same as an advance directive?
No. An advance directive (living will + healthcare proxy) expresses your wishes and has legal standing when you lack capacity. A POLST is a physician-signed medical order that translates those wishes into immediate clinical orders for use by EMS, hospitals, and nursing facilities. They serve complementary functions — a POLST is for people currently seriously ill; an advance directive is for everyone as general planning.
What is the difference between a POLST and a DNR?
A DNR (Do Not Resuscitate) order addresses only one decision: whether to attempt CPR. A POLST covers multiple treatment decisions: CPR, level of medical intervention (comfort only vs. limited interventions vs. full treatment), and artificial nutrition. A POLST is a more comprehensive medical order.
Who should have a POLST?
POLST is appropriate for people with serious illness or advanced age who have a high likelihood of a medical emergency in the next year. It is not designed for generally healthy adults — those people should have an advance directive instead. A primary care physician, hospice nurse, or palliative care team can assess whether a POLST is appropriate.
Does a POLST override my advance directive?
A POLST reflects your current wishes and typically takes precedence in emergency situations because it is a signed medical order that EMS can act on immediately. An advance directive provides context for more complex decisions. If there is a conflict between them, the most recent document and the patient's current expressed wishes should govern.
Can a POLST be revoked?
Yes. A patient with decision-making capacity can revoke a POLST at any time verbally or in writing. If you are incapacitated, your healthcare agent can work with your physician to update the POLST.
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