Washington State Printable Polst Form

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Washington State's Physician Orders for Life-Sustaining Treatment (POLST) form is a crucial document that outlines a patient's wishes regarding life-sustaining treatments. The POLST form is a portable medical order that ensures patients receive the medical treatment they desire, even when they are unable to communicate.

Understanding the POLST Form

The POLST form is a physician-order that outlines a patient's wishes regarding life-sustaining treatments, such as cardiopulmonary resuscitation (CPR), medical interventions, and other life-sustaining measures. The form is typically used for patients with serious illnesses or frailty, who may be at risk of cardiac or respiratory arrest.

Who Can Complete a POLST Form?

In Washington State, a POLST form can be completed by:

• Patients who are 18 years or older
• Patients who have the capacity to make their own medical decisions
• Patients who are represented by a healthcare proxy or agent

What is Included in a POLST Form?

A POLST form typically includes the following sections:

• Section 1: Cardiopulmonary Resuscitation (CPR)
• Section 2: Medical Interventions
• Section 3: Additional Instructions
• Section 4: Signature

Section 1: Cardiopulmonary Resuscitation (CPR)

In this section, patients can indicate whether they want to receive CPR if their heart stops beating or if they stop breathing. Patients can choose to receive CPR, not receive CPR, or indicate that the decision should be made by their healthcare provider.

Section 2: Medical Interventions

In this section, patients can indicate their preferences for medical interventions, such as:

• Antibiotics
• IV fluids
• Ventilator support
• Other medical interventions

Section 3: Additional Instructions

In this section, patients can provide additional instructions or information that they want their healthcare providers to know. This may include information about their values, preferences, or cultural beliefs.

Section 4: Signature

In this section, patients must sign and date the POLST form to indicate that they understand and agree with the instructions outlined in the form.

Benefits of a POLST Form

There are several benefits to completing a POLST form, including:

• Ensuring that patients receive the medical treatment they desire
• Reducing confusion and uncertainty among healthcare providers
• Providing patients with a sense of control and autonomy
• Encouraging patients to have conversations with their healthcare providers about their values and preferences

How to Obtain a Printable POLST Form

Patients can obtain a printable POLST form from their healthcare provider or by visiting the Washington State Department of Health website. The form can be completed and signed by the patient, and then shared with their healthcare providers.

Frequently Asked Questions

Here are some frequently asked questions about POLST forms:

• What is a POLST form?
• Who can complete a POLST form?
• What is included in a POLST form?
• How do I obtain a printable POLST form?

Conclusion

In conclusion, the POLST form is an important document that outlines a patient's wishes regarding life-sustaining treatments. By completing a POLST form, patients can ensure that they receive the medical treatment they desire, even when they are unable to communicate. We encourage patients to have conversations with their healthcare providers about their values and preferences, and to complete a POLST form to ensure that their wishes are respected.