Arkansas uses this two-page form for seriously ill or frail patients, or those receiving hospice care, whose treatment preferences should become an actionable medical order followed in all care settings. After a discussion, the physician records CPR status, a level of medical intervention and any additional orders, and both the physician and the patient or legal representative sign.
A physician completes Sections A through C based on the patient's preferences and medical indications and signs Section D. The patient, or a legal representative if the patient lacks capacity, also signs; both signatures are required for the form to be valid.
Download the current version from the source each time; forms change without notice.
Physician Order 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. The Arkansas Department of Health publishes a Spanish POLST form and directions alongside the English version. If a translated form is used with the patient or legal representative, the directions say to attach the translation to the signed English POLST form.
The form must be completed by a physician and signed by the physician and the patient, or the patient's legal representative if the patient lacks capacity. A legal representative can include a court-appointed guardian, an advance directive agent, a spouse, an adult child, sibling or relative, or another qualified surrogate.
No. POLST complements an advance directive and does not replace it. When an advance directive is available, review it alongside the POLST for consistency, and record in Section D whether one was available and reviewed. Review the POLST at transfers, substantial health changes or changed preferences.