The California POLST form (Physician Orders for Life-Sustaining Treatment) is a signed medical order that tells paramedics, nurses, and doctors which life-sustaining treatments you want and which you don’t. You can download the current version free from the Coalition for Compassionate Care of California at capolst.org, fill it out with a physician, nurse practitioner, or physician assistant, and it becomes legally binding the moment both of you sign it.1https://capolst.org Unlike an advance directive, which every adult should have, the POLST is designed for people who are seriously ill or medically frail and whose treatment choices may need to be acted on soon.
Who the Form Is For
The POLST is not meant for healthy adults. It’s for patients with serious illness, advanced frailty, or a condition likely to prompt emergency medical decisions in the near future. Typical candidates include people with advanced cancer, late-stage organ failure, or severe dementia. If you’re in good health, an advance directive is the right tool; the POLST becomes relevant once unwanted aggressive treatment is a real possibility.
Where to Get the Form
The current form, dated 2017, is available for free download from capolst.org. Hospitals, physician offices, and hospice programs also keep copies. Older versions remain valid, but using the current one avoids confusion. The signed version that emergency personnel follow must be completed in English, though translations exist in fourteen languages to help providers explain the choices to patients and families.
Filling Out the Form
At the top right, enter the patient’s full name and date of birth. These identifiers let responders confirm the orders belong to the person in front of them. A medical record number is optional. Date the form. If more than one POLST ends up in a patient’s chart, the most recent one controls.
The body of the form has three sections, each covering a different kind of decision.
Section A: Resuscitation
Section A applies only if you are found with no pulse and not breathing. You pick one of two options. Attempt Resuscitation/CPR means full CPR including defibrillation and a 911 call; choosing it requires you to also select Full Treatment in Section B. Do Not Attempt Resuscitation/DNR means no CPR, no defibrillator, and no advanced life support, though comfort measures are always provided. This is the first section responders look at when they arrive.
Section B: Medical Interventions
Section B governs treatment when you are still alive but need medical intervention. There are four choices, and the differences matter.
- Full Treatment covers all life-sustaining measures, including intubation, mechanical ventilation, cardioversion, ICU admission, and hospital transfer.
- Trial Period of Full Treatment means full treatment for a defined period to see whether your condition improves, with limits you and your provider write into the “Additional Orders” space.
- Selective Treatment allows IV antibiotics and short-term fluids, oxygen, suctioning, cardiac monitoring, and noninvasive breathing support such as CPAP or BiPAP, but no intubation and no mechanical ventilation.
- Comfort-Focused Treatment is limited to measures that relieve pain and discomfort: medication by any route, wound care, positioning, and oxygen or suctioning for comfort. No interventions aimed at prolonging life.
One constraint ties the two sections together. If you choose Attempt Resuscitation/CPR in Section A, you cannot select Comfort-Focused Treatment or Selective Treatment in Section B. Restarting a heart and then withholding the interventions needed to sustain it would be contradictory.
Section C: Artificially Administered Nutrition
Section C covers feeding tubes. Three options: long-term artificial nutrition, a trial period to see whether your condition improves, or no artificial nutrition at all. Nutrition decisions sit on their own because they involve different considerations than emergency resuscitation or acute medical treatment.
Signatures That Make It Binding
A POLST is a physician’s order, not a preference statement, and it becomes legally binding only once it carries two signatures. California Probate Code Section 4780 requires signatures from both the patient (or the patient’s legally recognized healthcare decision-maker) and a physician, nurse practitioner, or physician assistant acting within their scope of practice.2California Probate Code § 4780
The clinician’s signature certifies that the orders reflect a real conversation about your condition and goals. Without it, the form is at best a statement of preferences that providers aren’t obligated to follow. Without your signature, emergency responders don’t have to honor it either.
If you can’t sign, someone else can sign for you. California recognizes several categories of healthcare decision-makers: a healthcare agent you previously named through an advance directive, a court-appointed conservator, or a surrogate such as a family member or close friend you’ve identified verbally to your provider. If you haven’t designated anyone and can’t speak for yourself, your provider can select a family member or close friend who knows you and your wishes.
What Makes a POLST Invalid
Providers can legally decline to follow a POLST in two situations: it’s missing a required signature, or Section A has no selection marked. A form missing the provider’s signature may still be read as a general statement of wishes, but it doesn’t carry the force of a medical order. A physician also should not sign if the form doesn’t appear to reflect the patient’s informed choices, if the patient lacks capacity and no authorized decision-maker is involved, or if the requested treatment is medically inappropriate.
Storing and Displaying the Form
The official recommendation is to print the POLST on bright pink paper (Ultra Pink, 65-pound bond) so first responders can spot it. Pink is preferred, not required. A POLST printed, copied, scanned, or faxed on any color paper is legally valid, and all of those versions carry the same legal weight as the original.
At home, post the original somewhere highly visible. The refrigerator and the bedside table are the two most common spots in California. A clear plastic sleeve helps protect it. The original is your property and must travel with you between care settings. When you’re admitted to a hospital, transferred to a nursing facility, or enrolled in hospice, the pink original goes with you, and the sending facility keeps a copy in your record. A POLST locked in a safe defeats its purpose; the whole point is that it’s the first thing a paramedic or nurse sees when they walk in.
Changing or Revoking a POLST
You can revoke a POLST at any time, verbally or in writing. No special form is needed. If your condition changes or your goals shift, your provider can help you complete a new POLST. When a new form is created, mark the old one “VOID,” sign it, and date it so no one acts on stale orders. If more than one form ends up in your records, the most recently dated version controls.
A decision-maker or provider can also request changes based on new medical information. Changes made without the patient’s direct input should be discussed and agreed on by the provider and the decision-maker, and should match the patient’s known goals of care.
How It Works With an Advance Directive
A POLST complements an advance directive but doesn’t replace it. The advance directive is still the right place to appoint a healthcare agent and express broad values about end-of-life care. The POLST translates those values into specific orders that take effect immediately.
If the two documents conflict, say your directive calls for full treatment while your POLST specifies comfort care, your provider should confirm your current wishes and help you update both so they align. Until new documents are completed, providers follow the most recently documented preferences. That’s one reason the date on the form matters.
Cost
The form itself is free. The conversation with your provider is a medical visit. Medicare covers advance care planning under CPT code 99497. If the POLST discussion happens during your Medicare Annual Wellness Visit, the coinsurance and Part B deductible are waived. As a standalone visit outside the wellness exam, standard Part B cost-sharing applies. Most private insurance plans also cover advance care planning, with specifics varying by plan.
The ePOLST Registry and Out-of-State Limits
California is developing a statewide electronic POLST registry that would let providers pull up your orders digitally regardless of which facility you’re in. As of mid-2025, the California Emergency Medical Services Authority awarded the platform contract to ServiceNow, and the POLST Advisory Committee held its first meeting in May 2025. There is no public enrollment process yet. For updates, the state directs inquiries to the Health Information Unit at Healthinformation@emsa.ca.gov. Until the registry launches, the physical pink form is the primary document.
POLST forms are governed by state law, and each state has its own version with its own legal requirements. If you move or travel frequently, a California POLST may not be recognized by out-of-state providers. Contact the POLST program in the destination state to find out whether your orders will be honored or need to be reissued on that state’s form.