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POLST Resources

California & Texas

Physician Orders for Life-Sustaining Treatment form tells emergency personnel what treatments you would want in the event of a medical emergency. The current standard of care during an emergency is for medical professionals to do everything possible to attempt to save a life. Not everyone wants this treatment, and the POLST provides the option for you to (1) confirm this is the treatment you want or (2) to state what level of treatment you do want.

Physician Orders for Life-Sustaining Treatment form

POLST Forms – Physician Orders for Life-Sustaining Treatment

California & Texas

A POLST form is a portable medical order. In other words, it goes with you, the patient, wherever you are living.

  • A POLST form gives medical orders to emergency personnel based on your current medical situation. The form gives you choices about life-sustaining treatment, such as CPR, medical procedures, and feeding.
  • POLST forms tell other providers what you want. During a medical emergency, if you can talk, providers will ask you what you want. POLST forms are used only when you cannot communicate and you need medical care. When that is the situation, the POLST form orders providers to give you the treatments you chose.
  • POLST forms are completed with your doctor after discussing your medical conditions, what is important to you, what may happen in the future. Together you review your treatment options and make decisions. You can also change your decisions based on your health at any time. A doctor, physician assistant, or nurse practitioner must sign the POLST form for it to be valid. POLST forms vary by state.
  • POLST is voluntary. You make the choice about having a POLST form and you can change it whenever as you deem necessary.


POLST in Emergency Situations – Physician Orders for Life-Sustaining Treatment

California & Texas

In the event of an emergency, first responders such as the firefighters, police, or EMTs, will look for your POLST when they arrive at your home. That is why we encourage you to have it in an obvious, visible place (on your refrigerator or behind your front door). The POLST allows emergency medical personnel to make the care decisions you want when time is of the essence.

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