Arizona POLST Form: Who Needs One and How It Differs from an Advance Directive

What POLST Does That a Living Will Cannot

A Living Will in Arizona is a legal directive — it expresses your treatment preferences and becomes operative only when specific statutory conditions are met (terminal illness, vegetative state, irreversible coma). Medical staff must interpret it and decide how to apply it clinically.

A POLST (Physician Orders for Life-Sustaining Treatment) is a medical order. It translates your preferences into specific, immediately actionable instructions that clinicians follow without interpretation. POLST covers far more ground than a simple DNR: it addresses CPR, ventilation, antibiotics, artificial nutrition, hospitalization preferences, and comfort measures — all on one form that travels with you across every care setting.

Who Should Have a POLST in Arizona

POLST is not for healthy adults doing routine advance planning. It is designed for people who are:

• Seriously ill with a life expectancy of one year or less
• Chronically ill with frequent hospitalizations
• Frail and residing in a skilled nursing or assisted living facility
• Receiving hospice or palliative care services
• Living with advanced dementia or progressive neurological disease

If none of these apply to you, a Living Will and Healthcare POA are sufficient. POLST becomes relevant when your health status makes it likely that emergency interventions will occur in the near future.

How POLST Differs from a Prehospital DNR

Arizona's Prehospital DNR (the orange paper form) addresses one scenario only: cardiac or respiratory arrest outside a hospital. It instructs EMS not to perform CPR. It says nothing about ventilators, feeding tubes, antibiotics, or hospitalization.

POLST is comprehensive. It covers the full spectrum of life-sustaining interventions across all settings — home, ambulance, emergency department, hospital floor, nursing facility. A person with a POLST may still want to be hospitalized for comfort care while refusing CPR and ventilation.

You can have both documents. The POLST covers the broader range of clinical scenarios, while the Prehospital DNR provides the specific orange-paper format that Arizona EMS personnel are trained to look for at the scene.

Execution Requirements

Unlike a Living Will (which only needs your signature plus a witness or notary), POLST requires:

1. Patient signature — or the signature of a legally authorized healthcare agent if the patient lacks decision-making capacity
2. Provider signature — a licensed physician, nurse practitioner, or physician assistant must sign for POLST to become an active medical order

POLST is created through a clinical conversation between the patient (or their agent) and the provider. It reflects shared medical decision-making, not a unilateral legal declaration. The provider cannot refuse to discuss POLST, but they can decline to sign orders they believe are medically inappropriate — in which case the patient can seek another provider.

Where POLST Lives

POLST should be posted visibly — in the front of a medical chart at a facility, on the refrigerator at home, or in a clearly labeled folder. It should also be registered with the Arizona Healthcare Directives Registry (AzHDR) so that any hospital in the state can access it electronically during an admission.

When a patient transfers between facilities (hospital to nursing home, nursing home to hospice), POLST travels with them. It remains active until it is revoked or replaced by a new set of orders following a new goals-of-care conversation.

Coordinating POLST with Your Advance Directives

Your advance directives (Healthcare POA + Living Will) remain the foundation. POLST builds on them by converting your expressed preferences into clinical orders for your current health status. If your condition changes — improvement or decline — POLST should be updated through a new conversation with your provider.

The Arizona Advance Directive & Living Will Kit explains how all four documents (Healthcare POA, Living Will, Mental Health POA, and POLST/DNR) coordinate so your medical team has clear, consistent instructions regardless of the setting.

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