If you have a life-threatening illness, you should consider completing a California Physician Orders for Life-Sustaining Treatment (POLST) form to give yourself more control if you face a sudden medical emergency. This form is actually a doctor’s order that ensures your wishes are respected regarding end of life care. The POLST form was created by the Coalition for Compassionate Care of California and approved by the Emergency Medical Services Authority (EMSA). POLST forms are kept with your medical records and are generally pink, so they will stand out in the case of an emergency. Of course, you can change the terms or cancel the form any time you like.

A POLST form is broader than a Do Not Resuscitate (DNR) order, though it can also serve that function. Neither is it the same as an Advance Health Care Directive (AHCD). Let’s explore the differences.

Why You May Need a POLST Form Instead of or in Addition to a DNR Form

The POLST form has some similarities to the DNR form in that it can quickly inform medical personnel that if you suffer cardiopulmonary arrest, you do not want resuscitative measures such as chest compression (CPR), endotracheal intubation, defibrillation and heart-stimulating drugs. The POLST form may provide additional instructions about your desire for life-sustaining measures. Such life-sustaining measures may include use of antibiotics, feeding tubes, hydration, artificial nutrition and other emergency care that treats a variety of conditions including heavy bleeding, pain and breathing difficulties.

If you are subject to a life-threatening medical condition, and you do not want extraordinary measures taken to save you in an emergency situation, you should complete a POLST form. Of course, if you are responsible for the medical care of a relative who does not want these measures taken, you can help them to complete the form.

Why You May Need a POLST Form in Addition to an Advance Health Care Directive (AHCD)

You will also want to complete an Advance Health Care Directive. An AHCD is much more complete than a POLST form. It may include detailed information about your wishes concerning your healthcare, your health care agent and organ donation. Everyone should have an AHCD even if they have completed a DNR or POLST form. However only those with life-threatening medical conditions need a POLST form.

The reason to have a POLST even if you have an AHCD is that should you face a medical emergency, the staff who answers the call may not be able to read all the detail of an AHCD and understand in the heat of an emergency your wishes regarding resuscitation and life-sustaining measures. A POLST form, however, is clear, succinct and does not require a lot of interpretation.

How to Make a POLST Form

Should you enter a medical or long-term care facility, a health care professional there may ask if you would like to complete a POLST form. If not, of course you can ask the facility’s staff to help you.

A POLST form requires

  • Your signature or that of your legally appointed health care agent and
  • The signature of a doctor or a nurse practitioner or physician assistant acting for your doctor.

How Medical Personnel Can Know You Have a POLST (or DNR) Form When Outside of a Medical Facility

If you are outside of a medical facility that keeps your records, in the case of an emergency, health care providers can know you have completed a POLST or DNR form when you wear a medallion or bracelet for that purpose. There are three approved medallion providers for California :

StickyJ Medical ID
10801 Endeavour Way #B
Seminole FL 33777

MedicAlert Foundation
5226 Pirrone Court
Salida, CA 95368

Caring Advocates
2240 Encinitas Blvd., Suite D #334
Encinitas, CA 92024-4345