Washington POLST Form: What It Is, How to Get One, and When You Need It

If your loved one has a serious illness and you're worried about what happens when 911 is called, an advance directive alone won't protect them. Emergency responders don't read legal documents — they follow medical orders. In Washington, that order is the POLST.

The Portable Orders for Life-Sustaining Treatment is a clinical medical order developed under RCW 43.70.480 by the Washington State Medical Association and the Department of Health. Unlike an advance directive (which is a legal document you create yourself), a POLST is a physician-signed order that EMTs, paramedics, and hospital staff are legally required to follow.

POLST vs. Advance Directive: Key Differences

A healthy 45-year-old needs an advance directive. An 82-year-old with advanced heart failure needs both an advance directive and a POLST.

What the Washington POLST Covers

The form addresses three categories of emergency treatment:

Section A — CPR. If the patient has no pulse and is not breathing, should paramedics attempt resuscitation? Options: attempt CPR (full code) or do not attempt CPR (DNR).

Section B — Medical interventions. For patients who have a pulse but face a medical crisis: comfort-focused treatment only, selective treatment (IV fluids, basic diagnostics, but no intubation or ICU), or full treatment (all interventions including mechanical ventilation).

Section C — Antibiotics and artificially administered fluids. Whether to use antibiotics for infection and whether to provide IV or tube-fed nutrition and hydration.

How to Get a POLST in Washington

You cannot download a POLST and fill it out yourself. The process requires a conversation with a qualified clinician:

1. Initiate a goals-of-care conversation with the patient's physician, advanced practice registered nurse (ARNP), or physician assistant (PA)
2. Discuss specific clinical scenarios — what happens if the heart stops, if breathing fails, if a serious infection develops
3. The clinician completes the form based on the patient's stated preferences
4. Both the clinician and the patient (or surrogate) sign — the clinician's signature makes it a binding medical order
5. The form is printed on bright green cardstock — this distinctive color helps EMTs identify it immediately during an emergency

Making Sure EMTs Honor It

A POLST only works if it's accessible in an emergency:

At home: Post the bright green form on the refrigerator door or another highly visible location near the main entrance. When paramedics arrive at a home, the refrigerator is one of the first places they check. Don't file it in a drawer or a binder.

In a care facility: The POLST should be prominently placed in the patient's medical chart and travel with them during any transfer between facilities.

During transport: The form stays with the patient. When someone moves from home to a hospital, from a hospital to a nursing facility, or from a nursing facility to an ER, the POLST follows.

DNR at Home: Why a Hospital DNR Order Won't Work

A standard hospital DNR order is an internal clinical directive that applies only within that specific facility. When a patient goes home with a hospital DNR in the chart, that order has zero legal authority over the paramedics who respond to a 911 call.

If you call 911 for a loved one who is in cardiac arrest, EMTs will begin CPR — that's their default protocol and legal obligation. The only document that legally stops them is a completed, signed Washington POLST with "Do Not Attempt Resuscitation" checked in Section A.

Verbal requests from family members won't work. A living will sitting on the kitchen counter won't work. Even a hospital discharge summary noting "DNR" won't work. Only the green POLST form changes the default.

When to Review or Update a POLST

A POLST should be reviewed:

• When the patient's condition significantly changes (new diagnosis, major decline, or unexpected improvement)
• Upon transfer to a new care facility
• When the patient or family's treatment goals evolve
• At least annually, even if nothing has changed

To void a POLST, the signing clinician or another qualified provider draws a line through the form, writes "VOID," dates and signs it, and completes a new one if the patient's preferences have changed.

Building a Complete Plan

A POLST handles emergencies. An advance directive handles the legal framework — who makes decisions, what your long-term treatment philosophy is, what happens with your body after death. Washington's advance directive kit covers the legal side: DPOA-HC, Health Care Directive, body disposition instructions, and a POLST preparation guide that helps you walk into the goals-of-care conversation with your doctor already knowing what questions to ask.

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