The New Jersey POLST Form
The Practitioners Orders for Life Sustaining Treatment, or POLST form, must be filled by a doctor or nurse with a patient or decision maker. The POLST form tells the medical team what to do for a patient who is seriously ill or approaching the end of life. The form expresses the individual’s wishes about the specific types of care he or she would and would not like to receive. The NJ POLST form gives specific care instructions related to a patient’s personal goals of care, artificial nutrition, resuscitation and re-hospitalization.
This form should travel with a patient if they are moving between medical facilities; be in a visible place at home; and be in the chart of a hospitalized patient. The physicians who care for a patient should have a copy as well as appropriate family members or friends.
New Jersey POLST Forms (PDF):
Video Series:
An Introduction to the New Jersey POLST Form
2:50 min.
The Practitioners Orders for Life Sustaining Treatment or POLST form is written by a doctor or nurse and tells the medical team what to do for a patient who is seriously ill or approaching the end of life.
Completing the New Jersey POLST Form
6:20 min.
This video will help you prepare to complete a NJ POLST form with a health care provider. If you’re completing the NJ POLST form for someone else, check if there’s a living will or advance directive to guide decision making.
4Step iCare Plan
An Individualized End of Life Care Plan
Our 4Step iCare Plan is a simple, 4-step approach that helps patients, families, and healthcare providers navigate through challenging medical decisions.
Learn more with our video series and helpful tools
Get Involved!
As an agent of change. Join the Goals of Care Coalition of New Jersey to help improve end of life care for patients and families. As a supporter of our efforts. We depend on the generosity of our donors to provide critical information to patients and families—this information is provided at no cost when it’s needed most.
© 2019 Goals of Care Coalition of New Jersey / New Jersey Goals of Care
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