Montana's provider order form records CPR, medical intervention and artificial nutrition decisions so EMS and facilities can honor them, and it replaced the state's older Comfort One program. Clinicians complete it with the patient or legal decision-maker, and the patient keeps the original. The current form was revised January 2024, and previously completed forms stay valid until revised or revoked.
A Montana-licensed physician, APRN or PA signs the orders, and the patient, or legal decision-maker if the patient cannot make medical decisions, must also sign for the form to be valid. Section D records who took part in the discussion.
Download the current version from the source each time; forms change without notice.
POLST: Provider Orders for Life-Sustaining Treatment (Montana)
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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Terra green, a light lime green. DPHHS asks that printed forms use that color, and the patient should keep the original on green paper. Photocopies and faxes of a signed POLST are still legal and valid, so a copy can travel with the patient when needed.
Yes. Montana's POLST replaced the Comfort One program, and EMS and facilities honor it for CPR and scope-of-treatment decisions. Patients who want a visible identifier can add an optional POLST bracelet or necklace, requested through DPHHS with the separate bracelet and necklace order form.