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For questions about the POLST process, conversation, policies, program, and education, contact:


For questions about the statewide POLST eRegistry, technical assistance, or operations, contact:

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POLST Form Icon

Download The POLST Form

POLST forms can be ordered in bulk from Med-Pass

 

Translations of the POLST form are available to assist healthcare providers in explaining the form to patients and loved ones. However, an English version of the POLST form must be completed and signed so that emergency medical personnel and healthcare providers can follow the orders.

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POLST – Physician Orders for Life-Sustaining Treatment

Physician Orders for Life-Sustaining Treatment (POLST) is a form that gives seriously-ill patients more control over their treatment during a medical crisis or at the end of life, including CPR, ventilation/intubation, scope of interventions, and tube feeding.

Printed on bright pink paper, and signed by a patient or their legally recognized decision-maker and physician, nurse practitioner, or physician assistant, POLST can prevent unwanted or ineffective treatments, reduce patient and family suffering, and ensure that a patient's wishes are honored.
Download the California POLST form.

When you purchase your POLST forms through Med-Pass, you are supporting
the Coalition for Compassionate Care of California. Thank you!

The Coalition for Compassionate Care of California has created and compiled a variety of resources to help educate patients, caregivers, and healthcare professionals on the issues – both medical and deeply personal – surrounding POLST.