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 physician-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 terminal diagnosis and a prognosis of 12 months or less
• 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 under 65 who are doing routine advance planning do not need a POLST. A healthcare power of attorney and living will provide sufficient 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 physician. The POLST is a shared medical decision — the doctor 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 physician reviews each treatment category (CPR, scope of treatment, nutrition) and documents the patient's preferences as medical orders.

3. The physician 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 useless if paramedics cannot find it. The standard practice in Illinois is to keep the original form on the front of the refrigerator, clipped to a magnetic holder or taped at eye level. First responders are trained to check the refrigerator door first when looking for medical orders.

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 revoke a POLST at any time by telling their physician or by physically destroying the form. A healthcare agent can also request changes if the patient no longer has capacity — the physician must then issue a new POLST reflecting the updated orders.

Because medical conditions change, the POLST should be reviewed and re-signed at every major transition: a new diagnosis, a significant decline, a transfer between facilities, or at least annually for patients in long-term care.

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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