POLST is for people with serious illness or advanced frailty — it's NOT for healthy people

It overrides a standard advance directive for the specific orders it covers

Review with your doctor at every major health change or care transition

Advance PlanningmoderateDoctor signature required

POLST (Physician Orders for Life-Sustaining Treatment)

POLST · State Health Departments (46 states as of 2026)

Medical order (not just a directive) specifying life-sustaining treatment preferences. Actionable by EMS. For patients with serious life-limiting illness or advanced frailty. Works alongside advance directives.

Form Details

Total fields: 25
Auto-fillable: 14 (56%)
Time without BeneFill: 25 minutes
Time with BeneFill: 7 minutes
Time saved: 18 minutes
Filled by: both
Frequency: one time
State-specific: Yes — form may vary by state

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Where to Submit This Form

🏢

Keep the original with you — give copies to your doctor and hospital

POLST is a medical order, not just a document. It must be signed by a physician.

Required Attachments

📎 Must be signed by both the patient (or surrogate) and a physician/NP/PA

Processing Time

Effective immediately upon physician signature.

What Happens Next

Keep the ORIGINAL on your refrigerator door or bedside. EMS and hospital staff are trained to look for it. Give copies to all treating providers.

Tips for This Form

✓ POLST is for people with serious illness or advanced frailty — it's NOT for healthy people
✓ It overrides a standard advance directive for the specific orders it covers
✓ Review with your doctor at every major health change or care transition
✓ Bright pink or bright green form (varies by state) — designed to be easily found by EMS

You Might Also Need

Advance Directive / Living Will

State-specific · State Law (forms from AARP, state bar associations, hospitals)

Legal document specifying medical treatment preferences when the individual is unable to make decisions. Requirements for witnesses and notarization vary by state. Free state-specific forms available from AARP and state agencies.

Living Will (State-Specific)

Varies by state · State Legislatures / State Bar Associations

Written declaration of preferences regarding life-sustaining treatment, artificial nutrition and hydration, and comfort care when terminally ill or permanently unconscious. Legally distinct from healthcare proxy in many states.

Healthcare Power of Attorney / Healthcare Proxy

State-specific · State Law

Designates a trusted person (agent/proxy) to make healthcare decisions when the individual cannot. May be part of a combined advance directive or a separate document depending on state law.

MOLST (Medical Orders for Life-Sustaining Treatment)

MOLST · State Health Departments (e.g., New York)

New York's version of POLST. The only authorized form in NY for documenting non-hospital DNR and DNI orders. Must be completed by a physician in consultation with the patient or surrogate.

MOST / POST / COLST (State Variants)

MOST / POST / COLST · Various State Health Departments

State-specific variants of POLST: Medical Orders for Scope of Treatment (MOST), Physician Orders for Scope of Treatment (POST), Clinician Orders for Life-Sustaining Treatment (COLST). Functionally equivalent to POLST.

Do Not Resuscitate (DNR) Order

DNR (state-specific) · State Departments of Health

Medical order directing healthcare providers not to perform CPR if the patient's heart stops or they stop breathing. Cannot be created by the patient alone; requires physician signature. Comfort care always continues.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Health Departments (46 states as of 2026) or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.