POLST Information for Patients and Families

What is the POLST form?

The Provider Order for Life-Sustaining Treatment (POLST) form is a concise medical order completed by a person's physician, APRN or physician's assistant after a discussion to determine which treatments the patient wants and does not want near the end of life.

The POLST is introduced by a patient's health care provider when they are caring for frail or elderly patients or patients near the end of a serious, progressive disease. The form includes resuscitation orders and three levels of end-of-life interventions. The POLST cannot be honored unless it is signed by the patient their legal representative or surrogate and the patient's physician, APRN or physician's assistant.

What should I do with my completed POLST form?

The POLST should remain with a patient wherever treatment is provided. If at home, the POLST should be next to the patient's bed or on the refrigerator — both are locations where emergency medical service personnel are trained to look for it. The POLST form should be bright pink. Although valid, if the form is on white or another color paper it is recommended that patients ask their health care provider to get a pink one to assure ready recognition by other providers.

    What is the difference between a Nevada POLST form, an Advance Directive and a Do Not Resuscitate (DNR)?

    The POLST form complements an Advance Directive (AD) and is not intended to replace any type of AD. A Do Not Resuscitate (DNR) order only governs the withholding of resuscitation (when a person's heart stops and vigorous compressions are attempted to re-start it). There are two types of DNR: one is only for when a patient is in a health care facility, and the other is if a patient is outside of a health care facility.

    Click this link for more details.

      Guides for Nevada POLST and End-of-Life Planning and Decisions

      The following guides may be helpful in determining just how to make decisions about what end-of-life care a person wants. Nevada POLST hopes these guides will answer questions and help make decisions concerning treatment options near the end of life.

      Thank you to Coalition for Compassionate Care of California (CCCC) and the Supportive Care Resource Center of Allegheny Health Network , both well-respected organizations in the field of Advance Care Planning (ACP).