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

A family brings their mother's living will to the ER after a cardiac event. The paramedics glance at it and continue CPR. The document is legally valid, but it is not a medical order — and in an emergency, only a medical order stops treatment.

That is the gap the Illinois POLST form fills. It converts a patient's end-of-life preferences into a qualified-healthcare-practitioner-signed clinical order that first responders, nurses, and ER doctors must follow on contact — no interpretation, no phone calls, no waiting for a healthcare agent to arrive.

POLST vs. Living Will: The Critical Difference

A living will is a personal legal document. You sign it, a witness verifies it, and it sits in a folder until a physician reviews it during a hospitalization. It only activates when you have been diagnosed with a terminal condition where death is imminent and treatment would merely delay the dying process. Emergency responders are not trained to interpret living wills and are not legally bound to follow them in the field.

A POLST (Practitioner Orders for Life-Sustaining Treatment) is a medical order. It is signed by a qualified healthcare practitioner — in Illinois, that means a licensed physician, an advanced practice registered nurse, a physician assistant, or a medical resident in their second year or higher. Because it is a clinical order, it takes effect immediately. Paramedics, nursing staff, and hospital personnel treat it the same way they treat any other physician's order.

The POLST covers a broader range of interventions than a simple DNR. The form addresses CPR, mechanical ventilation, intubation, comfort-focused care, limited treatment versus full intervention, and artificially administered nutrition. A standard DNR only addresses resuscitation — it says nothing about whether to intubate, start IV antibiotics, or transfer to the ICU.

Who Should Have a POLST in Illinois

The POLST is not a general advance planning document. It is designed for people with serious, life-limiting conditions where a medical crisis is reasonably foreseeable:

• Patients with a serious or life-limiting illness who face a reasonably foreseeable medical crisis
• Residents of nursing homes, long-term care facilities, or hospice programs
• People with advanced chronic conditions (late-stage heart failure, COPD, renal disease, advanced dementia)
• Patients preparing for high-risk surgery who want immediate medical orders in place

Healthy adults doing routine advance planning generally do not need a POLST. A healthcare power of attorney and living will provide broader planning coverage for that group. The POLST becomes relevant when medical events shift from theoretical to probable.

How to Get the Form Signed

The official POLST form is managed by the Illinois Department of Public Health and the Illinois POLST Coalition. The form is available in multiple languages for patient comprehension, but the executed version must be printed and signed in English — first responders are trained to locate and read the English-language format.

The signing process:

1. Initiate the conversation with your healthcare team. The POLST is a shared medical decision — the qualified healthcare practitioner discusses your condition, prognosis, and treatment options with you or your legally authorized representative (healthcare agent, guardian, or surrogate under the Health Care Surrogate Act).

2. Complete each section of the form together. The qualified healthcare practitioner reviews each treatment category (CPR, scope of treatment, nutrition) and documents the patient's preferences as medical orders.

3. The qualified healthcare practitioner signs the order. Only a qualified healthcare practitioner can sign the POLST. A family member, healthcare agent, or attorney cannot sign this section.

4. The patient or representative signs the consent section. If the patient cannot physically sign, verbal or telephonic consent is legally acceptable under Illinois administrative guidance — but facility staff must document the consent method on the form.

No formal witness is required for the patient's consent on a POLST — this is different from the healthcare POA and living will, which both require witnesses.

Where to Keep the POLST

The POLST is useful only if paramedics can find it. Keep the original accessible and follow your care team's guidance about placement; responders need to be able to locate the order.

Additional copies should go to:

• Your primary care physician's office
• The nursing facility or hospice where you receive care
• Your healthcare agent's files
• Your electronic medical record (upload via MyChart or the hospital's patient portal)

If you move between facilities, the POLST transfers with you. Unlike a hospital-specific order set, the POLST is portable across all healthcare settings in Illinois.

Revoking or Updating the POLST

A patient with decision-making capacity can request a POLST change by communicating the request to the healthcare team. A healthcare agent or other legally authorized representative can request changes if the patient no longer has capacity; the qualified healthcare practitioner should issue a replacement POLST reflecting the updated orders.

Because medical conditions change, the POLST should be reviewed periodically and at every major transition: a new diagnosis, a significant decline, or a transfer between facilities.

How the POLST Fits With Your Other Documents

The POLST does not replace a healthcare power of attorney or living will. Each document serves a distinct function: the healthcare POA appoints an agent for all medical decisions, the living will states your preferences for terminal situations, and the POLST translates those preferences into actionable clinical orders.

The Illinois Advance Directive & Living Will Kit includes a POLST coordination guide that helps you align all three documents so your wishes are documented consistently across every healthcare setting — from the ambulance to the ICU to the long-term care facility.

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