Arkansas POLST Form: Who Needs One and How to Get It Signed

A living will says what you want. A POLST makes it happen. That's the difference most families discover too late — usually in an emergency room, after the interventions they explicitly refused have already begun.

The Arkansas Physician Orders for Life-Sustaining Treatment (AR POLST) form, established under the POLST Act of 2017, converts your advance care preferences into active, portable medical orders that travel with you across every healthcare setting. Here's who needs one, how to get it, and why a living will alone isn't sufficient.

What the POLST Form Actually Does

A POLST is a medical order — signed by a physician — that directs treatment decisions across all care settings: emergency departments, nursing homes, assisted living, hospice, and home care. It covers:

• Section A: Cardiopulmonary Resuscitation (CPR) — attempt resuscitation or do not attempt
• Section B: Medical Interventions — full treatment, selective treatment, or comfort-focused treatment
• Section C: Artificially Administered Nutrition — feeding tubes: long-term, trial period, or none
• Additional orders — antibiotics, hospital transfer preferences, dialysis

Unlike a living will (which only activates in terminal or permanently unconscious states), a POLST can apply during any serious medical event. It's an immediately actionable order set, not a future-oriented legal declaration.

Who Needs a POLST in Arkansas

A POLST is not for healthy adults doing routine advance care planning. It's designed for people with:

• Advanced progressive illness (cancer, COPD, heart failure, advanced dementia)
• Frailty or serious functional decline
• A life expectancy of roughly one year or less
• A current need for the medical system to know their treatment boundaries

If you're a healthy 45-year-old, a living will and healthcare agent appointment are sufficient. The POLST conversation happens when your medical situation makes emergency intervention decisions imminent — not hypothetical.

The Physician-Only Signature Requirement

This is the most common roadblock in Arkansas: only a licensed physician (MD or DO) can sign a valid POLST form. Arkansas does not extend signature authority to APRNs, Nurse Practitioners, or Physician Assistants.

In rural counties where many clinics operate with APRNs as the primary providers, this restriction means:

• You may need to schedule a specific appointment with the supervising physician
• Critical-access hospitals staffed primarily by APRNs may have delays getting orders signed
• If your regular provider is an NP, explicitly ask about the physician co-signature process

A POLST signed by a non-physician is legally invalid. Emergency responders and hospital staff will disregard it entirely.

How to Get Your POLST Form Completed

1. Initiate the conversation. Tell your physician you want to discuss goals of care and complete a POLST. Bring your existing living will or advance care plan so the physician can translate your documented preferences into medical orders.

2. The physician reviews and signs. The doctor assesses your medical condition, discusses treatment options with you (or your healthcare agent if you lack capacity), and signs the official Arkansas POLST form.

3. Print on pink paper. The completed POLST must be printed on bright pink paper — this is not aesthetic preference but a recognition standard. EMS and hospital staff are trained to look for the pink form.

4. Keep it visible and portable.

   • Post on the refrigerator at home
   • Place at bedside in nursing or assisted living facilities
   • Carry a copy in your medical binder if traveling between care settings
   • Ensure a copy is in your physician's electronic health record

POLST vs. Living Will vs. DNR: How They Work Together

These documents are complementary, not alternatives. A POLST doesn't replace your living will — it operationalizes it. Your living will provides the legal foundation; the POLST gives paramedics and nurses specific orders they can follow immediately.

Reviewing and Updating Your POLST

A POLST should be reviewed:

• At every significant change in health status
• Upon transfer between care facilities
• At least annually for patients with progressive conditions
• Whenever your treatment goals change

Your physician can void the existing POLST and issue a new one. You can also revoke it at any time by informing your treating provider.

Out-of-State POLST Forms

If you moved to Arkansas with a POLST from another state, it may not be immediately recognized by local EMS. While Arkansas honors out-of-state advance directives under § 20-6-103(h), the practical translation into local clinical operations varies. Have your Arkansas physician complete a new pink POLST form to ensure seamless emergency response.

Common POLST Mistakes in Arkansas

1. Printed on white paper instead of pink — EMS may not recognize it as a valid POLST during a time-critical response
2. Signed by an APRN or NP — legally invalid; full resuscitation will proceed
3. Filed in a drawer instead of displayed — a POLST buried in paperwork is a POLST that doesn't exist when it matters
4. Never updated after health changes — a POLST from two years ago may no longer reflect current treatment goals
5. Confusing POLST with a living will — a POLST is active immediately; a living will only activates upon physician determination of incapacity in a terminal/unconscious state

Connect Your POLST to Your Complete Advance Care Plan

A POLST works best when it's part of a coordinated system — not an isolated pink sheet with no supporting context. The Arkansas Advance Directive & Living Will Kit includes a POLST coordination tracker that helps you prepare for the physician conversation, a treatment preference matrix to bring to the appointment, and a distribution log ensuring copies reach every provider who needs them.

See more Arkansas guides →