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):
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.
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.
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