What does POLST stand for?

POLST stands for “Practitioner Orders for Life-Sustaining Treatment.”

What is the POLST Program?

POLST is a program you can choose to use to make sure your healthcare wishes are followed at the end-of life.

What information is included on the POLST form?

Some of the decisions that can be found on the POLST form are:

  • If your heart and breathing stops, would you want the emergency team to try to start them again (this is called CPR -Cardiopulmonary resuscitation)
  • Would you want to be put on a machine (called a ventilator) to help with breathing
  • Would you want to be fed through a tube if you could no longer eat


Is POLST required by law?

Filling out a POLST form is your choice. In Illinois, healthcare providers must do what a POLST form says by law.

Who should have a POLST form?

The POLST form is recommended for:

  • A patient who is very sick or frail, and may not live more than a year.

Does the POLST form replace a Healthcare Power of Attorney or Living Will?

No. The POLST form does not replace a Power of Attorney form or any other legal document such as a Living Will. Experts recommend that all adults should name someone to make healthcare decisions for them by using a Healthcare Power of Attorney form.

How do I fill out a POLST form?

A POLST form is filled out only after talking with your doctor or another healthcare professional about your medical condition and potential problems that may arise. Your options and treatment wishes would be put on the form, which must then be signed by your physician.

What should be done with the form after it is completed and signed?

The original POLST form stays with you at all times. If you are moved to another setting (such as from a hospital to a nursing home), the original POLST form goes with you.

Can I change my POLST form once it is completed?

Yes. If you decide to change your POLST form, write “VOID” on the front side of the form. A new form can then be completed with your healthcare provider showing your changes. The form with the latest date will be followed.

Does the POLST form expire?

No. However, it is recommended that you review it often, especially if there is a change in your health, you change your mind on what treatments you want or do not want, or you are moved from one care setting to another.

Who needs to see my POLST form?

Your doctor will have a copy of the form, but it is also a good idea to make sure your family knows you have a POLST form. Sometimes family members have their own ideas about what types of treatment their loved ones would want. POLST makes sure that your family members, caregivers, and healthcare workers know exactly what treatments you do and don’t want. No one has to guess or argue.

What happens if I don’t have a POLST form?

Emergency medical workers are required to do everything to keep you alive if a POLST form is not available. A POLST form helps healthcare workers and your loved ones know what treatments you would and would not want.

Can a POLST form be completed following a talk with someone other than me?

Ideally, providers want to know your wishes by speaking directly to you, so it is a good idea to talk to your doctor and your healthcare decision maker while you can. If something happens to you and you are unconscious, in a coma, or unable to talk, the POLST form can be completed by the individual you trust to make medical decisions for you– such as your healthcare agent (person you named on a healthcare power of attorney form), or surrogate (legal guardians, parents of a minor, and other decision-makers as defined by the Illinois Healthcare Surrogate Act list in order of priority).

Is the POLST form valid in other states?

The Illinois POLST form is valid in Illinois. If you are traveling to another state, it is recommended that you take your healthcare power of attorney form and your POLST form with you. Both documents, even if not legally binding in that state, will help healthcare providers know your wishes.

Is the POLST form available in other languages?

At this time, the Illinois POLST form is available in Spanish. Because the healthcare team must take immediate action in an emergency, it is a good idea to also fill out the form in English, even if you already filled a POLST form out in Spanish.

How does the POLST program ensure individuals are not harmed by POLST?


The POLST is specifically designed to assure that an individual’s treatment choices for end-of-life care are respected whether the choices are full treatment, selective treatment or comfort measures only. The orders on the form are based on a patient’s medical condition and his/her treatment choices. Use of the POLST form is completely voluntary. A POLST form is completed only after a discussion of end-of-life choices between a patient or his/her legal decision-maker and physician.


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