California POLST Form: What It Is, Who Needs One, and How to Get It

Families are often shocked to learn that a signed advance directive does not stop paramedics from performing CPR. In an emergency, EMTs are legally required to initiate full resuscitation unless a specific medical order — the POLST form — is physically present and visible.

Understanding the difference between these documents can prevent your loved one from receiving exactly the treatment they documented they didn't want.

What the California POLST Form Is

POLST stands for Physician Orders for Life-Sustaining Treatment. Codified under Assembly Bill 3000, it's a medical order printed on bright pink paper that translates a patient's treatment preferences into actionable clinical commands.

Unlike an advance directive (which is a planning document), the POLST is a set of doctor's orders that paramedics and hospital staff follow immediately — no interpretation required, no agent consultation needed.

Who Needs a POLST vs. an Advance Directive

These documents serve different populations:

Most people need an advance directive. Only those facing serious illness, advanced frailty, or end-of-life situations need a POLST in addition.

How the POLST Works in Practice

When paramedics arrive at a home, they look for a bright pink form — typically posted on the refrigerator or at the patient's bedside. The form specifies:

• Section A: Attempt resuscitation (full CPR) or Do Not Attempt Resuscitation (DNAR)
• Section B: Full treatment, selective treatment, or comfort-focused treatment
• Section C: Whether to provide artificial nutrition (feeding tubes)

If paramedics find a valid pink POLST, they follow its orders. If they find only a regular advance directive — even one clearly stating "no CPR" — they must initiate full resuscitation and let the hospital sort it out.

California POLST vs. Prehospital DNR

California has two clinical order documents:

POLST: Covers CPR, intubation, antibiotics, feeding tubes — the full range of life-sustaining treatment decisions. For patients with serious illness or frailty.

Prehospital DNR: Narrower — instructs responders to withhold only CPR (chest compressions, defibrillation, intubation, cardiotonic drugs). Other emergency care like pain management continues. Developed by EMSA and the California Medical Association.

Both must be signed by the patient AND a licensed physician, nurse practitioner, or physician assistant. Both are printed on pink paper. The POLST is more comprehensive; the prehospital DNR covers only the resuscitation question.

How to Get a California POLST

You cannot download and complete a POLST yourself. The process requires a clinical conversation:

1. Initiate the discussion with your physician, nurse practitioner, or physician assistant
2. Discuss treatment goals based on current diagnosis and prognosis
3. Complete the form together — the clinician fills it out based on the shared conversation
4. Both parties sign — patient (or legally authorized surrogate) and the clinician
5. Print on pink paper and keep the original with the patient

The form is available through the California POLST Coalition (capolst.org), but it requires a clinician signature to be valid. An unsigned POLST is meaningless.

Critical Rules About Changes

Under EMSA guidelines, any manual alteration to a POLST or DNR form — crossing out sections, white-out, handwritten amendments — immediately renders the form void. Paramedics must ignore altered forms and begin full resuscitation.

To change your POLST instructions: complete an entirely new form with your clinician and physically destroy the old one.

Coordinating Your POLST with an Advance Directive

The POLST doesn't replace your advance directive — they work together:

• Your advance directive names who makes decisions (your healthcare agent) and documents your values and general preferences
• Your POLST converts those preferences into specific standing medical orders

If a situation arises that your POLST doesn't cover, your healthcare agent steps in using the values documented in your advance directive as guidance.

Getting Both Documents Right

The California Advance Directive & Living Will Kit explains exactly how the AHCD and POLST coordinate, includes a POLST reference guide so you know what to discuss with your physician, and provides the advance directive framework that every Californian needs as the foundation for their care planning — whether or not a POLST is clinically appropriate right now.

See more California guides →