POLST form

The national POLST form carries one sentence that explains the whole document:

This is a medical order, not an advance directive.

An advance directive is a legal document you write. A POLST is a medical order a clinician signs, after a conversation with you, about the treatment you should receive now. That difference is not academic. It decides what happens in your driveway at two in the morning.

Why paramedics cannot act on your advance directive

The national POLST organisation states it plainly: legal documents such as advance directives "are not orders that EMS providers can follow." Medical orders like the POLST form "provide emergency personnel with the specific treatments that are desired during an emergency."

This is the part families find out too late. A signed, witnessed, notarised advance directive in a drawer does not direct a paramedic. Emergency responders act on medical orders.

	Advance directive	POLST
What is it	Legal document	Medical order
Who should have one	All adults	Anyone seriously ill or frail
Who fills it out	You	A health care professional, after discussion with you
Can it appoint your decision-maker	Yes	No
Can emergency responders use it	No	Yes

Both halves of that last pair matter. A POLST works where the directive cannot. The directive does something the POLST cannot do at all.

Who it is for

POLST is for people who are already seriously ill or frail. The form states its own criterion: the process is for patients "who are at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty."

If you are healthy, you do not need one, and an advance directive is the right tool instead. Worth saying clearly, because the urge to get every document in order leads people to collect forms designed for someone in a different situation.

You may have seen the "surprise question", whether a clinician would be surprised if this person died within a year, offered as the test. That phrasing is common in clinical writing, but it is not the criterion the national POLST organisation publishes. The published standard is the one quoted above.

It is in addition to an advance directive, never instead of one

The National Institute on Aging puts it in six words: POLST and MOLST forms "serve as a medical order in addition to your advance directive."

The mechanical reason is in the comparison. Asked whether it can be used to appoint your surrogate, the POLST answer is no. A POLST cannot name the person who speaks for you. Only a medical power of attorney or health care proxy does that.

So the pairing for someone seriously ill is both documents, saying the same thing:

• An advance directive or medical power of attorney, naming your decision-maker and stating what you want.
• A POLST, signed by your clinician, translating that into orders EMS and hospital staff can act on immediately.

If the two disagree, you have created a problem for the people trying to help you. Have them reviewed together.

The name changes at the state line

POLST stands for Physician Orders for Life-Sustaining Treatment, and it is now used as a generic label for portable medical orders.

Your state may call it something else. New York uses MOLST, Medical Orders for Life-Sustaining Treatment. Tennessee and Louisiana use POST, for Scope of Treatment. Kansas and Missouri use TPOPP.

The national organisation counted the problem precisely: as of December 2017 there were "47 existing POLST forms to review, essentially, 47 variations of the same concept using 16 names and five different colors."

That last detail answers a question people ask often. The form is frequently printed on bright paper so it is findable in a hurry, but the colour is a state convention, not a universal rule, five different colours were in use across those 47 forms. Do not assume a form is invalid because it is the wrong colour, and do not assume a coloured page is a POLST.

Only your state's form works

This is the practical trap. POLST programmes are run by each state, not by the national organisation, and the forms genuinely differ.

The national body is direct about it: "POLST programs have developed separately in each state, resulting in inconsistencies among different state forms," and "only state-developed and approved forms are valid." Using a generic national form where the state has not adopted it "may jeopardize patient care if implemented incorrectly."

The national form carries its own warning: it "can only be used in states that have adopted it" and "must be adopted by the state before it can be completed in that state as a valid POLST form."

Find your state's programme and its current form at polst.org/state-programs, which lists all fifty states and the District of Columbia. Then ask your clinician for that form, not a version downloaded from anywhere else.

A signed form is not self-enforcing

Two things go wrong in practice, and both are worth planning around.

It has to be found. A POLST is useful only if it is where the paramedics will look. That generally means on the refrigerator, in a clearly marked folder by the door, or in a state registry where one exists. A POLST in a safe deposit box is decoration.

A DNR is narrower than people think. A do-not-resuscitate order addresses cardiac or respiratory arrest. It is not a general instruction about treatment, and it is not an advance directive. A POLST covers more ground, resuscitation, level of medical intervention, and in some states artificial nutrition, which is why sections of the same form can produce outcomes families did not expect. If the form says one thing for a person without a pulse and something different for a person still breathing, those are two separate instructions and both will be followed.

Read the sections with the clinician who signs it, and ask what each one means for a specific scenario you are worried about. Ask what happens if you are breathing but unresponsive. Ask what happens to a feeding tube already in place. Generic answers are not useful here.

Changing or revoking it

A POLST can be changed or revoked. Because it is a medical order, the change goes through the clinician, the form is reviewed, a new one signed, and the old one voided. Ask your clinician for their process, and ask them to review it whenever the condition changes materially or the person moves between care settings.

What to do

If you are healthy: you do not need a POLST. Complete an advance directive and a medical power of attorney using your state's form.

If you or your parent is seriously ill or frail: ask the treating clinician directly whether a POLST is appropriate, using your state's name for it. It is a conversation, not a download. The form is signed by a professional, and in many states it cannot be completed without one.

Then put it where someone will find it in ninety seconds.

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The 72-Hour File has a medical section that records which documents exist, where each one is kept, and who already has a copy, including whether a POLST or DNR is in the chart. See what is inside