How to Fill Out and Submit the Oregon POLST Form: Sections, Signatures, Registry

The Oregon POLST form is a medical order that tells paramedics, EMTs, and hospital staff what life-sustaining treatment a seriously ill patient does and does not want during a crisis. You cannot fill one out on your own. A qualified Oregon healthcare professional completes it with you (or your surrogate) during a face-to-face conversation, signs it, and submits it to the statewide POLST Registry so your orders can be retrieved electronically anywhere in Oregon.¹

Who the Form Is For

POLST is not meant for every adult. It is designed for people with an advanced progressive illness or significant physical frailty where death in the foreseeable future would not be surprising.² That generally means conditions like advanced heart or lung disease, metastatic cancer, end-stage organ failure, or progressive neurological decline. Clinicians use screening questions to decide whether a POLST is appropriate, such as whether the disease is in an advanced stage, whether the patient is in significant decline, or whether they are already in palliative care or hospice.³

Nobody is required to have one. Oregon law states that neither patients nor healthcare professionals are obligated to create or sign a POLST, and no facility can require it as a condition of admission or care.⁴ If you are a healthy adult looking to document your general wishes, what you likely want is an Advance Directive instead. More on how those two differ further down.

How to Get a Blank Form

Patients cannot order blank POLST forms. Only healthcare professionals and medical organizations can order them from the Oregon POLST program, and they are sold in bulk to hospitals, clinics, hospices, and skilled nursing facilities.⁵ The first step is scheduling an appointment with your doctor or another qualified clinician to talk through your condition and whether a POLST fits your situation.

A sample form is available for free download on the Oregon POLST website so you can look over the choices before your appointment. The sample cannot be used as an actual medical order; it is for education only.⁵ Many Oregon healthcare systems now use an electronic version called ePOLST, which lets your clinician complete and submit the form digitally and cuts down on transcription errors.

What You’ll Decide in the Conversation

The 2023 Oregon POLST is printed on brightly colored paper so it stands out in a chart or at home. It is organized into sections labeled A through E. The three sections that drive the real decisions are A, B, and D.

Section A: Cardiopulmonary Resuscitation

Section A only applies when a person has no pulse and is not breathing. The choice is binary: attempt resuscitation (CPR) or do not attempt resuscitation (DNAR). There is no middle option, because once the heart stops the choice is to intervene immediately or to allow a natural death. If you choose DNAR here but select a higher level of care in Section B, those Section B orders govern any emergency where you still have a pulse.³

Section B: Medical Interventions

Section B sets the level of treatment when you have a pulse but are in medical crisis. There are three tiers:

Full Treatment uses every available intervention, including intubation, mechanical ventilation, advanced airway measures, and cardioversion.
Selective Treatment allows IV fluids, IV antibiotics, and standard medical treatment, plus non-invasive positive airway pressure like a BiPAP mask, but no intubation.
Comfort-Focused Care relieves pain and suffering through medication, positioning, and wound care. Oxygen and suctioning can be used for comfort. The aggressive interventions listed in the other tiers are not used.

The distinction matters in practice. Choosing Comfort-Focused Care tells responders not to transport you to an ICU for aggressive intervention. Choosing Selective Treatment tells them to treat the problem but keep you off a ventilator. These choices should come out of a conversation with your clinician about realistic outcomes given your condition.³

Section D: Who Was Involved in the Discussion

Section D records who participated in the POLST conversation. The form asks whether the discussion was with the patient, a parent of a minor, a person appointed under an advance directive, a court-appointed guardian, or another relative or friend acting as a support person. Names and relationships of everyone involved are listed.⁶ This creates a record that the orders came from an actual conversation.

Who Signs the Form

Only the healthcare professional signs the POLST. You do not sign it. The POLST is a medical order, not a contract, and the clinician’s signature attests that the orders are consistent with your current condition and preferences.⁶

The professionals authorized to sign an Oregon POLST are:

Physicians (MD or DO)
Nurse Practitioners (NP)
Physician Associates (PA)
Naturopathic Physicians (ND), authorized since January 2018⁷

The signing clinician must be licensed in Oregon or otherwise permitted to practice in the state. A signature can be physical, electronic, or a verbal order documented according to standard medical practice, as long as the facility’s or community’s policy allows it.⁶

If the Patient Cannot Participate

When the patient lacks decision-making capacity, a surrogate takes part in the POLST conversation on their behalf. If the patient has an advance directive naming a healthcare representative, that person has priority. Otherwise, Oregon law uses a default list, in order: a court-appointed guardian authorized to make healthcare decisions, the spouse, an adult designee chosen by the others on the list (as long as no one on the list objects), a majority of the patient’s adult children who can be located, either parent, a majority of the patient’s adult siblings who can be located, and then any other adult relative or close friend.⁸ The clinician still signs the form. The surrogate’s role is to convey the patient’s known values and preferences, which get documented in Section D.

Submitting the Form to the Registry

Once the form is signed, it should go to the Oregon POLST Registry, a secure statewide database housed at OHSU that lets emergency personnel pull up your orders electronically when the paper form is not at hand. There are three submission routes:

Fax to 503-418-2161.
Mail to Oregon POLST Registry, 3181 SW Sam Jackson Park Rd, Mail Code BTE234, Portland, OR 97239.
eSubmit through a Secure File Transfer Protocol (SFTP) connection, which requires an Electronic Submissions User Agreement; healthcare organizations can request one by emailing polstreg@ohsu.edu.

The Registry does not accept forms by email.⁹ Healthcare systems using ePOLST can submit directly through their electronic health records, which is the fastest route and avoids transcription errors. For questions, the Registry can be reached at 503-418-4083 locally or 877-367-7657 toll-free.¹⁰

Keep the original signed paper form, or a printed copy, somewhere visible at home. On or near the refrigerator is the usual spot. When paramedics arrive on a 911 call, they will look for the brightly colored form before they have time to query the electronic registry.

Changing or Revoking the Form

You can revoke a POLST at any time and in any manner that communicates intent to revoke. Oregon law places no restrictions on how or when a patient (or their representative) changes their mind.⁴

To void a paper form, draw a line through sections A through E and write “VOID” in large letters across the front. Send a copy of the voided form to the Oregon POLST Registry so it can be removed from the database, and contact your health system, clinic, or facility so they can void or remove their copy from their records.¹¹ Missing any of these steps risks outdated orders being followed later.

If your condition or treatment goals change but you still want a POLST, a new form has to be completed from scratch. Handwritten edits on a signed form are not valid. The new form requires another conversation with a qualified clinician and a fresh signature. Once the replacement is signed and submitted, the old orders are superseded.

How the POLST Differs From an Advance Directive

People often mix up the POLST and the Advance Directive, but they do different jobs. An Advance Directive is a legal document any competent adult can create. It names a healthcare representative to make future decisions and records general wishes about treatment. Emergency medical personnel cannot follow an Advance Directive directly, because it is not a medical order.

A POLST is a medical order signed by a clinician. Paramedics, EMTs, and hospital staff are required to follow it. It applies only to people with serious progressive illness or frailty, and it addresses specific clinical scenarios like cardiac arrest and the use of a ventilator. When both documents exist for the same patient, the POLST governs emergency treatment decisions because it carries the actionable orders. If the two conflict, the clinician should work with the patient or surrogate to reconcile them and issue updated orders reflecting current wishes.¹²

1
National POLST Collaborative. History of POLST
2
Oregon POLST. Oregon POLST
3
Oregon POLST. Guidance for Oregon’s Health Care Professionals
4
Oregon Laws. ORS 127.672 – POLST Not Required; Revocation
5
Oregon POLST. Ordering Oregon POLST Forms and Materials
6
Oregon POLST. Sample 2023 Oregon POLST
7
Legal Information Institute. Oregon Administrative Code 333-270-0020 – Scope and Applicability
8
Oregon State Legislature. Oregon Revised Statutes – Chapter 127
9
Oregon POLST Registry. Form Registration
10
Oregon POLST Registry. Contact
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Oregon POLST. Patients and Family
12
Oregon POLST. Oregon POLST Resources