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How do I fill this out?

To fill out the POLST form, begin by discussing the patient's current medical condition and wishes with them or their legally authorized representative. Ensure that all sections relevant to the patient's treatment preferences are completed accurately. Finally, have the form signed by a licensed healthcare provider to validate it.

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How to fill out the Hawaii POLST Provider Orders for Life-Sustaining Treatment?

  1. 1

    Discuss the patient's wishes and medical condition.

  2. 2

    Complete all relevant sections of the POLST form.

  3. 3

    Have the form signed by the patient or their legally authorized representative.

  4. 4

    Ensure the healthcare provider completes their signature and details.

  5. 5

    Provide copies of the completed form to relevant parties.

Who needs the Hawaii POLST Provider Orders for Life-Sustaining Treatment?

  1. 1

    Healthcare providers who need to follow specific patient treatment orders.

  2. 2

    Patients who want to ensure their end-of-life care preferences are respected.

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    Family members looking to create a clear directive for loved ones in medical emergencies.

  4. 4

    Surrogates acting on behalf of patients who are unable to communicate their wishes.

  5. 5

    Advanced Practice Nurses requiring a valid POLST for patient care management.

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  1. 1

    Open the POLST PDF in the PrintFriendly editor.

  2. 2

    Select the text or areas you wish to edit.

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    Make necessary changes according to the patient's preferences.

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    Review your edits to ensure information accuracy.

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    Save changes and proceed to download or share the document.

What are the instructions for submitting this form?

To submit the POLST form, ensure all sections are completed and signed appropriately. You can fax the completed form to your healthcare provider or send it via email, if preferred. Physical copies should be provided to relevant healthcare entities at transition points, ensuring that all involved parties have access to the document.

What are the important dates for this form in 2024 and 2025?

Important dates include the adoption of this form in May 2023. Regular reviews of the POLST are recommended when there are health changes or transfers. Future updates to the form may occur, so keep an eye on revisions in 2024 and 2025.

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What is the purpose of this form?

The purpose of the POLST form is to ensure that patients' wishes regarding life-sustaining treatment are clearly documented and followed. It serves as a crucial tool for healthcare providers in making informed decisions about a patient’s care. The goal is to respect patient autonomy while providing appropriate medical interventions.

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Tell me about this form and its components and fields line-by-line.

The POLST form includes several key components necessary for documenting patient treatment preferences.
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  • 1. Patient Information: Contains essential details such as patient's name, date of birth, and emergency contact.
  • 2. Cardiopulmonary Resuscitation (CPR): Indicates the patient's wishes regarding resuscitation efforts.
  • 3. Medical Interventions: Details the patient's preferences for various levels of medical interventions.
  • 4. Artificially Administered Nutrition: Specifies the patient's choices related to nutrition and hydration.
  • 5. Signatures: Includes signatures from the patient or their representative and the healthcare provider for validation.

What happens if I fail to submit this form?

Failing to submit the POLST form may result in healthcare providers not following your treatment preferences. This can lead to unwanted medical interventions that do not align with your wishes. It is crucial to ensure the form is completed and submitted appropriately to avoid any confusion in medical emergencies.

  • Miscommunication: Healthcare teams may not understand a patient's treatment preferences, leading to inappropriate care.
  • Legal Issues: Without a submitted POLST, there may be legal challenges regarding the enforcement of a patient’s wishes.
  • Delayed Treatment: Unclear directives can result in delays in receiving care that aligns with the patient's wishes.

How do I know when to use this form?

Use the POLST form when a patient has a serious illness and wants to convey specific treatment preferences. It is particularly important during transitions between care settings or when health conditions change. This form serves to communicate the patient’s wishes to all healthcare professionals involved in their care.
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  • 1. Serious Illness: When a patient has a serious medical condition requiring careful treatment planning.
  • 2. End-of-Life Care: To ensure that desired care measures are implemented at the end of life.
  • 3. Care Transitions: Whenever a patient is moving from one healthcare facility to another.

Frequently Asked Question

What is the POLST form?

The POLST form is a medical order that outlines a patient's preferences for life-sustaining treatment.

Who can complete the POLST form?

The POLST form should be completed by a healthcare professional in consultation with the patient or their representative.

How do I ensure my POLST is valid?

Your POLST form must be signed by a licensed healthcare provider along with the patient or their legally authorized representative.

Can I modify my POLST?

Yes, you can modify your POLST at any time by completing a new form or indicating changes on the original.

Is POLST the same as an Advance Directive?

No, POLST is a medical order, while an Advance Directive provides overall guidance for future medical decisions.

What should I do if my health status changes?

It is advisable to review and potentially update your POLST form if there are any significant changes in your health.

How can I share my POLST with family members?

You can easily share the PDF version of your POLST with family members through email or printed copies.

What do I do if I want to rescind my POLST?

To rescind your POLST, simply communicate your intention and complete a new form that reflects your current wishes.

Are there any fees associated with using PrintFriendly?

Using PrintFriendly to edit and download your POLST is completely free.

Can I print my POLST after editing?

Yes, once you have edited your POLST form, you can easily print it for your records.

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Hawaii POLST Provider Orders for Life-Sustaining Treatment

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