Arizona's POLST program uses the 2025 National POLST Form for people who are seriously ill or medically frail and want their treatment wishes written as portable medical orders. A physician, PA or nurse practitioner completes it after discussing diagnosis, options and goals, recording CPR status, initial treatment level, additional orders and medically assisted nutrition. Both the patient and the provider sign.
A physician, physician assistant or nurse practitioner completes Sections A through D with the patient and signs Section F; the patient or surrogate signs Section E.
Download the current version from the source each time; forms change without notice.
National POLST Form: A Portable Medical Order (Arizona)
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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Yes, but only with a living will. The Arizona Healthcare Directives Registry accepts a POLST if it is attached to a living will, so AzHDR recommends updating the living will when the POLST is completed and registering them together. Copies can also go to the healthcare power of attorney, family and providers.
AzHDR describes the form as designed for people who are seriously ill or medically frail, not for generally healthy people. The National POLST Form itself is for patients at risk of a life-threatening clinical event from a serious life-limiting condition, which may include advanced frailty. Completing it is always voluntary.