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POLST – Physician Orders for Life-Sustaining Treatment – is a physician’s order that outlines a plan of care reflecting the patient’s wishes concerning care at life’s end. The POLST form is voluntary and is intended to:

• Help you and your doctor discuss and develop plans to reflect your wishes for your review with qualified legal advisors, and
• Assist physicians, nurses, health care facilities, and emergency personnel in honoring a person's wishes for life-sustaining treatment.fornia

Click here to read and print a blank Physician Orders for Life-Sustaining Treatment (POLST) form for your personal use.  


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The Healthcare Power of Attorney (Advance Directive) Advance Health Care Directive: What's Important to You

After reading the following information, you may Click Here to read and print a blank Healthcare Power of Attorney (Advance Directive) for California.

An "advance health care directive" lets your physician, family and friends know your health care preferences, including the types of special treatment you want or don't want at the end of life, your desire for diagnostic testing, surgical procedures, cardiopulmonary resuscitation and organ donation.

By considering your options early, you can ensure the quality of life that is important to you and avoid having your family "guess" your wishes or having to make critical medical care decisions for you under stress or in emotional turmoil.

ADVANCE HEALTH CARE DIRECTIVE CHECKLIST

The material prepared for this checklist is intended as informational only and not as legal advice. "If you are unsure of your options or have questions, we suggest that you talk with your physician, your lawyer and other trusted advisors."

• GATHER INFORMATION FOR DECISION-MAKING. Your physician is a good place to start for understanding your options on health care treatment at the end of life. In addition, many organizations have information that may be useful.
• DISCUSS YOUR END-OF-LIFE DECISIONS WITH KEY PEOPLE. Talk about your decisions with your family, physician and others who are close to you. Some questions to consider for discussion:
  • What is important to you when you are dying?
  • Are there specific medical treatments you especially want or do not want?
  • When you are dying, do you want to be in a nursing home, hospital or at home?
  • What are the options in Palliative Care/Pain Management and Hospice Care?
• PREPARE YOUR ADVANCE CARE DIRECTIVE FORM. Under state law, you have a legal right to express your health care wishes and to have them considered in situations when you are unable to make these decisions yourself. California consolidated various earlier forms used to indicate health care preferences into one Advance Care Directive. All valid health care directives executed before July 1, 2000 can remain in effect under California Probate Code section 4701. Earlier forms included Natural Death Act Declaration, Directive to Physicians and Durable Power of Attorney for Health Care.
• DESIGNATE PERSON TO CARRY OUT WISHES. Select who should handle your health care choices and discuss the matter with them. You could name a spouse, relative or other agent.
• INFORM KEY PEOPLE OF YOUR PREFERENCES. Notify your doctor, family and close friends about your end-of-life preferences. Keep a copy of your signed and completed advance health care directive safe and accessible. This will help ensure that your wishes will be known at the critical time and carried out. Give a copy of your form to:
  • The person you appoint as your agent and any alternate designated agents
  • Your physician
  • Your health care providers
  • The health care institution that is providing your care
  • Family members
  • Other responsible person who is likely to be called if there is a medical emergency