The Wisconsin POLST form — Physician Orders for Life-Sustaining Treatment — is a medical order that turns a seriously ill patient’s treatment choices into instructions clinicians and emergency responders can act on immediately. A physician or nurse practitioner fills it out after a goals-of-care conversation with the patient or their decision-maker, and the completed form then follows the patient across hospitals, nursing homes, ambulances, and home. Unlike a power of attorney for healthcare, which names someone to make future decisions, a POLST records the decisions themselves as standing orders.
Who the Form Is Meant For
POLST is designed for people who are seriously ill or medically frail, not for healthy adults doing general future planning. The clinical guideline in wide use is that a healthcare professional would consider a POLST appropriate when they would not be surprised if the patient died within the next year. That threshold isn’t a prediction. It’s a way of flagging patients whose medical situation is unstable enough that responders may need standing orders in place before a crisis.
Hospice patients, residents of long-term care facilities, and people managing advanced progressive conditions like end-stage heart failure or metastatic cancer are the primary users. Healthy adults are better served by a standard advance directive such as Wisconsin’s power of attorney for healthcare, which handles broader and longer-term planning.
How to Get a Blank Form
The Wisconsin POLST form is not on the Wisconsin Department of Health Services advance directives page, which carries only the living will, power of attorney for healthcare, power of attorney for finances, and authorization for final disposition. You can get the form through the National POLST Collaborative at polst.org, through a primary care clinic, or through a hospital or hospice program. Many healthcare systems in Wisconsin keep blank copies on hand and start the conversation when a patient’s condition warrants it.
The form is typically printed on bright lime green paper so responders can spot it instantly among other paperwork. A black-and-white copy printed from a PDF is also accepted, though the green version is strongly preferred for visibility.
What the Form Covers
The POLST isn’t something you complete alone at the kitchen table. A healthcare professional fills it out during or after a conversation about your treatment goals, values, and current medical reality, then translates those preferences into medical orders across the form’s main sections.
Section A: Resuscitation
This section applies only when the patient has no pulse and is not breathing. The two choices are attempt resuscitation (CPR) or do not attempt resuscitation, allowing natural death. This is the section that overlaps with a traditional DNR order, and the choice here gives first responders a clear directive the moment they arrive.
Section B: Medical Interventions
Section B governs treatment when the patient still has a pulse or is breathing but cannot communicate. Three levels are available:
- Comfort measures only. Treatment focuses on pain relief and symptom management. No intubation, no intensive care, no hospital transfer unless needed purely for comfort.
- Limited additional interventions. Basic treatments such as IV fluids and antibiotics are used, but the patient is not placed on a ventilator or admitted to intensive care.
- Full treatment. All medically appropriate interventions, including intubation, mechanical ventilation, and intensive care admission.
The choice should reflect what the patient actually wants day-to-day care to look like given the current condition, not what they might want under some hypothetical future scenario.
Artificial Nutrition and Antibiotics
The form also includes checkboxes for artificially administered fluids and nutrition (feeding tubes, IV hydration) and for how far antibiotics should be used or withheld. Patients should always be offered food and fluids by mouth if they can swallow safely; this section addresses what happens when they cannot. Additional notes can be written on the form, but the standardized checkboxes are what responders rely on first.
Who Signs the Form
A Wisconsin POLST requires the signature of a physician or nurse practitioner to be valid as a medical order. The Wisconsin Attorney General’s analysis of the form found that it “requires no patient’s signature or witnessing for a patient’s signature.” That differs from the state’s power of attorney for healthcare, which requires the principal’s signature and witnesses.
Even so, many POLST programs and the National POLST Collaborative recommend that the patient or their authorized decision-maker also sign, to document that a real conversation took place and that the orders reflect the patient’s wishes. The conversation is the foundation the form rests on. Orders written without genuine input from the patient or their representative undermine the entire purpose of the document.
If the patient lacks decision-making capacity, a healthcare agent named under a power of attorney for healthcare, a court-appointed guardian, or a surrogate decision-maker identified under Wisconsin’s surrogate consent framework can take part in the conversation. Wisconsin law sets a priority order for surrogates: spouse or domestic partner first, then adult children, parents, adult siblings, grandparents, adult grandchildren, and finally a close friend or relative who has maintained regular contact with the patient.
Where to Keep the Completed Form
The completed POLST should stay with the patient. For someone living at home, the standard advice is to keep the lime green form on the front of the refrigerator or another spot EMS crews are trained to check. A form buried in a filing cabinet might as well not exist; the whole point is instant visibility during a crisis.
When a patient transfers between facilities, the form travels with them. Providers should also place a copy in the electronic medical record so every member of the care team can see the orders. Additional copies with family members and the primary care clinic are a reasonable backup.
Changing or Revoking the Form
A POLST is not permanent. A patient with decision-making capacity can revoke or change it at any time, verbally or in writing. If a patient tells a paramedic or nurse “I want to be resuscitated,” that spoken wish overrides the written order on the spot. Wisconsin’s DNR statute makes the same point, and the principle carries over to POLST orders. Current expressed wishes always take priority over a previously completed form.
When medical circumstances change meaningfully, whether a new diagnosis, a period of improvement, or a shift in goals, the form should be reviewed with the healthcare professional and updated through a new conversation. The old form is voided by drawing a line through it, writing “VOID” across it, and completing a new one. Every change should be documented in the medical record with the date, the participants, and the reasons.
A legally recognized healthcare decision-maker can also request changes or revoke the form on behalf of a patient who has lost capacity, as long as the changes are consistent with the patient’s known wishes or best interests.
Traveling or Living Out of State
POLST forms are governed state by state, and no federal law requires one state to honor another state’s form. Terminology, rules, and recognition vary. A Wisconsin POLST may not be automatically accepted if the patient is transported to or receives care in another state. Patients who split time between states or travel often should raise this with their provider and consider completing a POLST in each state where they receive care.
Legal Status in Wisconsin
Wisconsin recognizes three statutory instruments for expressing healthcare wishes: a declaration to physicians (the living will), a do-not-resuscitate order, and a power of attorney for healthcare. Each carries specific legal protections for providers who follow it. The POLST is a separate tool, and a Wisconsin Attorney General opinion noted that it does not fit neatly into any of the three statutory categories.
That distinction matters for provider immunity. Providers who follow a statutory DNR bracelet order are shielded from criminal and civil liability under Wisconsin Statutes section 154.23. The Attorney General’s office has observed that a POLST lacking the features of those statutory documents “will trigger no statutory immunities for healthcare providers,” though a court might still treat the form as evidence of the patient’s intent.
In practice, POLST forms are widely used across Wisconsin’s healthcare system and are treated as valid medical orders by hospitals and emergency responders. The form also covers more than a DNR alone, addressing overall scope of treatment and artificial nutrition, which a DNR bracelet does not. If you want the strongest possible legal footing in Wisconsin, pair the POLST with a power of attorney for healthcare and, when appropriate, a statutory DNR order.