Skip to Content
End of Life Washington
Text Size:   A-   A   A+   ?

Click the buttons to the left to change this site’s font size.

You may prefer to use your browser’s “Zoom” feature (usually press “CTRL” and “+” or go to “View” > “Zoom”).

Full Instructions

POLST Couple

POLST forms and information brochures can be obtained by calling your medical provider or by calling End of Life Washington at 206.256.1636 or emailing


Physician Orders for Life-Sustaining Treatment

Physician Orders for Life-Sustaining Treatment

Physician Orders for Life-Sustaining Treatment

A Physician Orders for Life-Sustaining Treatment (POLST) form (formerly called the EMS – No CPR form) is intended for any adult, 18 years of age or older, with serious health conditions.

The POLST form accomplishes two major purposes:

● It is portable from one care setting to another.

● It translates wishes of an individual into actual physician orders.

 Why should I make a POLST?

The truth is that health care providers frequently ignore advance directives, and the law isn’t much help. No state forces a doctor or hospital to follow instructions in an advance directive. POLST, however, represents your wishes as clear medical orders. POLST improves your chances of getting what you want and avoiding what you do not want at the end of life. We recommend POLST to all our clients.

You (or your health care agent) and your physician may use POLST to write clear and specific medical orders that indicate what types of life-sustaining treatment you want or do not want at the end of life. Both the patient and a physician must sign the bright green form in order for it to be honored by other health care professionals.

No witnessing or notarizing is required.

Emergency Medical Services (EMS) personnel are required to honor POLST, and it remains with you if you are transported between care settings.

The POLST form is relatively new in Washington, and many physicians are still unaware of it. If your physician does not have POLST forms available, ask her or him to contact the Washington State Medical Association, or contact our office to request one by mail (not available via email).

Click here to download the POLST information brochure.

Properly completed, the POLST form is probably the most effective advance directive because your wishes are expressed as medical orders.

*For more information about the POLST form, visit the Washington State Medical Association’s website. 

WordPress by MRW Web Design – Websites for Nonprofits