California's POLST is a portable medical order for patients with serious illness or frailty, recording choices about CPR, the level of medical intervention and artificially administered nutrition. A physician, NP or PA completes it after a conversation with the patient or decisionmaker, both sign, and health care providers must then follow it; the original travels with the patient and a copy stays in the record.
A physician, or a nurse practitioner or physician assistant acting under physician supervision and within scope of practice, completes Sections A to C and signs Section D. The patient, or a legally recognized decisionmaker when the patient lacks capacity, also signs Section D, and page 2 names the supervising physician and any preparer.
Enter the patient's last, first and middle names, date of birth and the date the form is prepared; the medical record number is optional. The header reminds readers to follow these orders first and then contact the physician, NP or PA, and that any section not completed implies full treatment for that section.
Section A applies only if the patient has no pulse and is not breathing. Check one: Attempt Resuscitation/CPR, or Do Not Attempt Resuscitation/DNR (Allow Natural Death). Choosing CPR requires Full Treatment in Section B. With DNR, no defibrillator, including an AED, or chest compressions should be used. DNR does not mean do not treat; any Section B option may still be chosen.
Section B applies when the patient has a pulse or is breathing. Check one: Full Treatment (intubation, mechanical ventilation and cardioversion as indicated), with an optional box for a trial period; Selective Treatment (medical treatment, IV antibiotics and IV fluids, no intubation, non-invasive airway pressure allowed, generally avoid intensive care); or Comfort-Focused Treatment. A patient who wants IV fluids needs Selective or Full Treatment. Additional Orders can address dialysis, transfusions or antibiotics, though local EMS may not implement them.
Food by mouth is offered if feasible and desired. Check one: long-term artificial nutrition, including feeding tubes; a trial period of artificial nutrition, including feeding tubes; or no artificial means of nutrition. Use the Additional Orders line for specifics, such as the length of a trial. If the patient is undecided the section may be left blank, but providers will then assume full treatment.
Mark whether the orders were discussed with the patient (who has capacity) or with a legally recognized decisionmaker, and whether an advance directive was available and reviewed, not available, or does not exist, naming any health care agent. Print the physician, NP or PA name, phone and license or certification number, then sign and date. The patient or decisionmaker prints their name and relationship, signs, dates and gives a mailing address and phone.
Repeat the patient's name, date of birth and gender. When an NP or PA signs, record the supervising physician's name and phone; record the preparer if someone other than the signer prepared the form, and any additional contact. The directions below explain who may act as a decisionmaker, that a decisionmaker may sign only if the patient lacks capacity or has made that authority immediately effective, and that a translated form is attached to the signed English one.
Review the POLST when the patient transfers between care settings or levels, when health status changes substantially, or when preferences change. A patient with capacity can revoke it at any time by any means showing intent. To document revocation, draw a line through Sections A to D, write VOID in large letters, then sign and date the line; keep the voided form in the record. A decisionmaker may request changes based on the patient's known wishes.
Download the current version from the source each time; forms change without notice.
Physician Orders for Life-Sustaining Treatment (POLST)
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A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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Since January 1, 2016, a physician (MD or DO), or a nurse practitioner or physician assistant acting under the supervision of a physician and within their scope of practice, can sign under Probate Code Section 4780. The patient, or the legally recognized decisionmaker if the patient lacks capacity, must also sign. Verbal orders are acceptable if followed by the clinician's signature per facility or community policy.
No. The POLST does not expire, and a patient does not need a new one after moving between facilities or changing doctors. It should be reviewed when the patient moves from one care setting or level to another, when health status changes substantially, or when treatment preferences change. A new form is only needed when the patient's wishes change.
A Spanish translation is posted on caPOLST.org alongside translations in Armenian, Chinese, Farsi, Hmong, Japanese, Korean, Pashto, Portuguese, Punjabi, Russian, Tagalog and Vietnamese. These are for reference and patient education only. The English POLST must be completed and signed so EMS and other providers can follow the orders, and a translation used in the conversation is attached to it.
No. Selecting Attempt Resuscitation/CPR in Section A requires selecting Full Treatment in Section B, because resuscitation involves invasive measures such as intubation that comfort-focused care excludes. The reverse is allowed: a patient can choose Do Not Attempt Resuscitation/DNR with Full Treatment, receiving every life-sustaining measure while alive but no CPR once pulse and breathing stop.