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Washington POLST Form (WSMA): Portable Medical Orders

Washington's POLST turns a seriously ill or frail person's treatment wishes into portable medical orders, and outside a medical facility it is the only set of orders the Department of Health approves for EMS. Page 1 sets CPR orders (Section A), the level of medical interventions (Section B) and signatures (Section C); page 2 records decision makers, a nutrition preference and reviews.

Who completes it

An MD/DO, ARNP or PA-C completes the orders after a conversation with the individual and signs; the individual or their legal medical decision maker must also sign. Other health care professionals who helped can be listed on page 2.

Submitting and payment

How to submit it
The original goes home with the patient and travels with them on every transfer or discharge. Copies, digital images and faxes of the signed form are valid, so keep one in the record.
Who pays
WSMA lets clinicians and organizations print the form themselves or order printed forms through its online shop; the form carries no fee or billing code.

Good to know

  • Any incomplete section implies full treatment for that section, and the most recent POLST replaces all previous orders.
  • Bright green card stock is recommended, but the form is honored on any color. Pocket cards and bracelets are not officially sanctioned, and medics cannot act on them alone.
  • To void, draw a line across the page, write VOID in large letters, and notify everyone who holds a copy. Any change requires a new POLST.
  • A parent or guardian signs for a patient under 18, and virtual, remote and verbal consents and orders are acceptable under facility policy.

Get the official form

Download the current version from the source each time; forms change without notice.

Portable Orders for Life-Sustaining Treatment (POLST)

Official pagePDFVersión en español

Fill it with Vero

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.

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How this list is checked

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Who can sign a Washington POLST?

The orders must be signed by an MD, DO, ARNP or PA-C, and by the individual or their legal medical decision maker under guardianship, a DPOA-HC or RCW 7.70.065. A parent or guardian signs for a child under 18. WSMA advises clinicians not to pre-sign forms or send one home for the patient to complete alone.

Is a faxed or copied POLST valid in Washington?

Yes. The form states that copies, digital images and faxes of a signed POLST are legal and valid, and you may make copies for records. Send the original with the individual whenever they are transferred or discharged. A POLST printed on paper other than green is also honored.

Is the Washington POLST available in Spanish?

Yes. WSMA posts the form and patient brochure in Spanish and 16 other languages, including Chinese, Russian, Somali, Ukrainian and Vietnamese. WSMA notes the translations are provided for educational purposes only, so they support the conversation with patients and families rather than replace the English form.