Alaska POLST Form: How It Works, Who Signs It, and How It Differs from an Advance Directive

If you've heard about Alaska transitioning away from Comfort One and you're unsure what replaced it, the answer is the Physician Orders for Life-Sustaining Treatment — POLST. It's a medical order, not a legal planning document, and that distinction changes everything about how it's used.

What the Alaska POLST Is (and Isn't)

A POLST is a clinician-signed medical order sheet that dictates specific treatment parameters for patients with advanced, chronic, or terminal illness. Unlike an advance directive, which documents your general wishes for hypothetical future scenarios, a POLST translates those wishes into binding medical orders for foreseeable clinical events.

Key differences:

A POLST doesn't replace your advance directive. You need both — the directive appoints your healthcare agent and documents broad preferences, while the POLST gives EMS and hospital staff actionable orders.

Who Can Sign an Alaska POLST

This changed significantly on November 8, 2022. House Bill 392 amended AS 13.52.65 to authorize Physician Assistants and Advanced Practice Registered Nurses to sign POLST forms and DNR orders. Before this change, only physicians could sign.

That expansion matters enormously in rural Alaska, where PAs and APRNs are frequently the only clinicians available in village health clinics.

Under Alaska law, a POLST is legally binding even without the patient's or surrogate's signature, as long as an authorized clinician signs it. However, because most other states require the patient's signature for cross-border recognition, getting the patient or representative to co-sign is strongly recommended.

The Comfort One to POLST Transition

The Comfort One program ran from October 1996 until Alaska stopped resupplying enrollment packets to healthcare facilities on June 1, 2022. If you or a family member has a completed Comfort One form, card, or bracelet signed before the transition, it remains legally valid and must be honored by all emergency responders.

The MOST (Medical Orders for Scope of Treatment) form was used in some facilities during the transition period but was never legislated as a statewide medical order and provides no statutory immunity for clinicians. The Alaska Department of Health recommends transitioning any MOST records to POLST.

How EMS Handles Conflicts

When first responders arrive and find multiple documents, they follow the recency rule — the most recently signed document controls. If a 2019 Comfort One form says "DNR" but a 2024 POLST says "Full Treatment," they follow the POLST.

If any section of a POLST is left blank, EMS defaults to full treatment for that parameter while enforcing the completed sections. Families who want a DNR order recognized by local dispatch can fax the completed POLST with a HIPAA-compliant coversheet — forms indicating full treatment don't need to be faxed since that's already the default response.

If family members on scene demand treatment that conflicts with a valid POLST, EMS contacts On-Line Medical Control for guidance. If the conflict can't be resolved, they stabilize and transport to a hospital where the attending physician or ethics committee makes the call.

Getting a POLST Completed

You can't fill out a POLST yourself — it requires a clinical conversation with your provider about your current health status and treatment goals. The clinician then translates those goals into specific medical orders.

The advance directive, however, is entirely within your control. Having a well-documented directive makes the POLST conversation faster and more accurate because your clinician can reference your stated preferences rather than starting from scratch.

The Alaska Advance Directive & Living Will Kit covers exactly how the AHCD and POLST work together, including when to request a POLST and how to ensure both documents stay synchronized as your health changes.

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