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POLST formThe 2016 California Physician Orders for Life-Sustaining Treatment (POLST) form is now available for individual download and bulk purchase, allowing health care providers to be ready Jan. 1, 2016, when nurse practitioners and physician assistants – under the supervision of a physician and within their scope of practice – are authorized to sign POLST forms and make them actionable medical orders under Assembly Bill 637.

Changes to POLST in 2016

On the front of the POLST form, changes were made to Section D: Information and Signatures, to allow space for NP and PA signature and license/certification information. On the back of the form, there is now a space for NPs and PAs to note the name of their supervising physician and new information under the Directions for Healthcare Providers section.

The Emergency Medical Services Authority (EMSA) Commission approved the revisions earlier this month.

Have questions?

On November 19, more than 600 health care professionals attended a webinar about the new POLST form and the impact of AB 637. Download and read this document (PDF) answering 36 questions asked during the webinar. (An encore presentation of this webinar is available on YouTube.)

Still have questions? Contact us.


  • AB 637 does not go into effect until Jan. 1, 2016. POLST forms signed by nurse practitioners or physician assistants prior to that date will not be valid.
  • Previous versions of POLST are still valid.
  • Best practice is for NPs and PAs to only use the revised POLST form (with an effective date of 01/1/2016) because previous versions do not contain the necessary signature lines or clarifying language and instructions.

2 Responses to “2016 POLST form now available”

  1. Lisa Dushais

    Is there a location to get the original bright pink form. My mother had one and it hung on her wall in assisted living facility. Very obvious. She has passed but want to get something similar for both myself and my husband. Relieves family from any decision making can be modified by person and decisions can be made when there is no imminent crisis. Big fan. Wish all states had POLST

    • Lisa,
      We agree – the POLST is a wonderful tool for end-of-life decisionmaking and we applaud you for taking action to do your own advance care planning. We can mail you a hard copy of the POLST form, or you should be able to obtain a copy of the POLST form from your primary care doctor.
      However, while anyone can complete a POLST, it should be noted that the POLST is intended for people who are seriously ill or within the last year of life.
      Younger, healthier individuals should complete an advance health care directive instead of a POLST. Why? Because POLST should be completed in discussion with your physician and based on your current health condition and prognosis. The choices about life-sustaining treatment become much more focused when a person has a serious illness. An advance directive is designed for anyone over the age of 18, and is based on future “what if” –type care needs. With an advance directive you outline your overall philosophy on the care you would want if you have a future health crisis – whatever that may look like – and name a trusted individual to voice your wishes in the event you can’t speak for yourself.
      – Kelley


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