Completed jointly by a patient and a practitioner, this New Jersey order records goals of care and orders on medical interventions, artificial nutrition, CPR and airway management. Once signed it becomes part of the medical record and is valid in all New Jersey care settings. The New Jersey Hospital Association hosts the form, which follows the 2011 law and was revised in August 2019.
A physician, advance practice nurse or physician assistant completes the orders and signs with license number, date and time; the signature is mandatory. The person or surrogate signs Section F, and Section E records whether a surrogate may later change the orders.
Download the current version from the source each time; forms change without notice.
New Jersey Practitioner Orders for Life-Sustaining Treatment (POLST)
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. NJHA posts the standard green form in English and Spanish, and the mass-printing version in English, Spanish, Korean, Vietnamese, Russian and Hindi. Provider FAQs are available in English, Spanish, Vietnamese and Korean, and a consumer brochure in English and Spanish.
Draw a line through all sections, write VOID in large letters, and sign and date the line. A person with decision-making capacity can modify or void it at any time. Completing and signing a new POLST also voids any earlier POLST documents, which the practitioner should explain.