This actionable medical order for people facing terminal illness or advanced frailty is based on the National POLST form, which the Maine POLST Coalition adopted in 2019. It records CPR, initial treatment, additional orders and medically assisted nutrition. It is not meant for healthy older adults, who are pointed to an advance directive instead, and it travels with the patient across settings.
A physician, nurse practitioner or physician assistant signs Section F after a conversation with the patient or representative; the patient or representative signs Section E. Page 2 records the advance directive review and anyone who helped prepare the form.
Download the current version from the source each time; forms change without notice.
Maine POLST (Physician Orders for Life-Sustaining Treatment)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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.
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The Maine Hospice Council posts the current form as a sample watermarked Do Not Copy. To get copies without the watermark, the practice or facility completes the Council's Printing Release and User Agreement and sends it to the Maine Hospice Council, which administers POLST in Maine.
No. The form states that it does not expire, but it should be reviewed when the patient moves between care settings, has a substantial change in health, changes primary provider or changes treatment preferences. Verbal orders are acceptable with a follow-up provider signature.