The Michigan POLST form, officially called the Michigan Physician Orders for Scope of Treatment or MI-POST, is a one-page medical order that tells emergency responders and healthcare staff what treatment a seriously ill patient does and does not want. You get it as a free download (form MDHHS-5836) from the Michigan Department of Health and Human Services website, and you complete it with your attending physician, physician assistant, or certified nurse practitioner.1Michigan Department of Health and Human Services. MI-POST Because it carries the force of a physician’s order, EMS crews and facility staff act on it immediately rather than pausing to interpret a living will.
Who the Form Is For
The MI-POST is voluntary and designed for a narrow group: adults with an advanced illness or frailty for whom, based on their current condition, death would be expected within a year.2Michigan Department of Health and Human Services. Michigan Administrative Rules R 325.81 to R 325.87 – MI-POST “Advanced illness” means a condition with significant functional impairment that curative therapies cannot reverse and that is expected to progress toward death despite treatment. No formal written prognosis is required; the attending health professional uses clinical judgment.
If you are generally healthy or your conditions are stable, this is not the right form for you. It exists for patients in late-stage cancer, advanced organ failure, severe dementia with complications, and similar situations where an unplanned emergency room visit could easily trigger interventions the patient would never have chosen.
Where to Get the Form and What It Costs
Download MDHHS-5836 at no cost from the MDHHS website. Paper copies are also available at hospitals, nursing facilities, and physician offices that participate in the program.1Michigan Department of Health and Human Services. MI-POST The form itself is free. Your clinician may bill for the advance care planning conversation, but Medicare covers that discussion, and when it happens during the Annual Wellness Visit the deductible and coinsurance are waived.3Centers for Medicare and Medicaid Services. Billing and Coding: Advance Care Planning (A58664)
How to Complete the Form
Before signatures, the attending health professional reviews the MI-POST patient information sheet with the patient or the patient’s representative, and that signed sheet goes into the medical record.2Michigan Department of Health and Human Services. Michigan Administrative Rules R 325.81 to R 325.87 – MI-POST If no patient advocate has been named yet, the health professional should suggest the patient think about naming one. The form itself has three substantive sections.
Section A: Cardiopulmonary Resuscitation
Section A applies only when the patient has no pulse and is not breathing. There are two choices:4Michigan Department of Health and Human Services. Michigan Physician Orders for Scope of Treatment (MI-POST)
- Attempt Resuscitation/CPR, meaning EMS performs chest compressions, uses a defibrillator, and takes other life-saving measures. Choosing this option requires choosing Full Treatment in Section B.
- Do Not Attempt Resuscitation (DNR), meaning no CPR is performed and a natural death is allowed.
EMS looks at this box first. A clear choice here prevents confusion in the most time-sensitive moment of any emergency.
Section B: Medical Interventions
Section B governs treatment when the patient still has a pulse or is breathing. Pick one of three levels:5Michigan Society for Healthcare Risk Management. Michigan Physician Orders for Scope of Treatment
- Comfort-Focused Treatment prioritizes comfort. It includes pain medication by any route, positioning, wound care, oxygen, manual suctioning, and non-invasive breathing support as needed for comfort, with food and water by mouth as tolerated. Aggressive interventions are not used.
- Selective Treatment adds IV fluids, cardiac monitoring, cardioversion, and non-invasive airway support such as CPAP or BiPAP. Intubation and mechanical ventilation are not included. Hospital transport may happen; intensive care is generally avoided.
- Full Treatment adds intubation, mechanical ventilation, advanced airway interventions, and other aggressive measures. Hospital transport and intensive care are expected.
Sections A and B have to line up. Choose CPR in A and you must choose Full Treatment in B. Choose DNR in A and any of the three Section B levels is available.
Section C: Additional Orders
Section C is a blank space for specific orders about treatments the patient wants started, withheld, or stopped. The form gives examples: dialysis, medically assisted nutrition such as feeding tubes, long-term life support, medications, and blood products.4Michigan Department of Health and Human Services. Michigan Physician Orders for Scope of Treatment (MI-POST) This section is optional, but it is where someone can spell out, for example, that they want antibiotics for comfort but no feeding tube.
Signatures That Make It Valid
A valid MI-POST needs two signatures: the patient (or the patient’s representative) and the attending health professional.6Legal Information Institute. Michigan Admin Code R 325.83 – Completing the MI-POST The attending health professional can be a physician, physician assistant, or certified nurse practitioner with primary responsibility for the patient’s treatment.2Michigan Department of Health and Human Services. Michigan Administrative Rules R 325.81 to R 325.87 – MI-POST If a nurse practitioner or physician assistant signs, the form must also list their collaborating physician’s name and phone number.7Michigan Department of Health and Human Services. MI-POST Frequently Asked Questions
When the patient cannot be physically present with the health professional, verbal or telephone orders are acceptable. The person preparing the form fills in the health professional’s name, date, phone number, and collaborating physician information if applicable, then writes “verbal order” or “telephone order” on the signature line. The attending health professional then strikes through that notation and personally signs within ten calendar days.2Michigan Department of Health and Human Services. Michigan Administrative Rules R 325.81 to R 325.87 – MI-POST
If the Patient Cannot Sign
When a patient lacks capacity to make medical decisions, a patient representative can sign in their place. Under Michigan’s rules, a patient representative is either a patient advocate named in a Patient Advocate Designation (also called a Durable Power of Attorney for Health Care) or a court-appointed legal guardian with authority to make medical decisions.7Michigan Department of Health and Human Services. MI-POST Frequently Asked Questions A spouse, adult child, or other family member who has not been formally designated as a patient advocate does not have the legal authority to sign. This is a common misunderstanding, and it is a frequent reason families run into problems at the worst possible time.
Where to Keep the Form and Who Gets a Copy
The original stays with the patient. Paper, fax, and digital copies are all valid and should go to every provider involved in the patient’s care, and healthcare facilities and physician offices must keep the most current copy in the medical record.2Michigan Department of Health and Human Services. Michigan Administrative Rules R 325.81 to R 325.87 – MI-POST
For patients living at home, post the original somewhere visible, like the refrigerator or the back of the front door, so EMS can find it quickly. During a transfer between a nursing facility and a hospital, the form travels with the patient. The form is useless if no one can find it when it matters.
How Long It Lasts and How to Change It
A completed MI-POST is valid for one year from the date the attending health professional authorized it.2Michigan Department of Health and Human Services. Michigan Administrative Rules R 325.81 to R 325.87 – MI-POST After that, you need a fresh conversation with your health professional and a new form.
A patient can revoke or change the form at any time and by any means they can communicate: spoken word, written statement, or any other expression of intent.8Legal Information Institute. Michigan Administrative Code R 325.84 – Reaffirming or Revoking the MI-POST General A patient representative can also revoke it if that is consistent with the patient’s wishes, or in the patient’s best interest when those wishes are unknown.9Legal Information Institute. Michigan Administrative Code R 325.86 – Revoking the MI-POST
The physical revocation has two steps. Write “revoked” over the most recent signatures of both the patient (or representative) and the attending health professional, then write “void” in large, bold ink diagonally across both sides of the form.9Legal Information Institute. Michigan Administrative Code R 325.86 – Revoking the MI-POST You cannot simply edit a MI-POST. To change your treatment preferences, void the old form and complete a new one with your attending health professional. Then notify every provider and facility that has a copy so their records are updated. A revoked MI-POST sitting in a nursing home chart that no one knows was voided can lead to exactly the kind of unwanted treatment the form was meant to prevent.
How the MI-POST Differs From a Living Will or DNR
The MI-POST is not an advance healthcare directive; the administrative rules say so directly.2Michigan Department of Health and Human Services. Michigan Administrative Rules R 325.81 to R 325.87 – MI-POST A living will or healthcare power of attorney records your wishes and names someone to speak for you, but EMS personnel generally cannot act on those documents in the field. A MI-POST is a physician’s order, so EMS can follow it immediately without waiting for additional authorization.
A standard DNR covers one question only: whether to attempt CPR. The MI-POST covers CPR and goes further, addressing the level of medical intervention you want while you still have a pulse, plus specific treatments like dialysis or feeding tubes.
None of these documents replaces the others. A Patient Advocate Designation names the person who speaks for you when you cannot. A living will records your values and general treatment wishes. The MI-POST translates those preferences into specific, actionable medical orders that first responders and facility staff follow in real time. A patient with serious illness ideally has all three.