Edit, Download, and Sign the Pennsylvania POLST Form Instructions and Guidelines

Form

eSign

Email

Add Annotation

Share Form

How do I fill this out?

To fill out the POLST Form, start by discussing your healthcare preferences with your medical provider. Consider your values and wishes about medical treatments at the end of life. Once you and your healthcare provider have determined your preferences, complete the form by providing the necessary signatures.

imageSign

How to fill out the Pennsylvania POLST Form Instructions and Guidelines?

  1. 1

    Discuss your treatment preferences with a healthcare professional.

  2. 2

    Consider your values regarding end-of-life care and specific treatments.

  3. 3

    Complete the POLST Form with your medical provider.

  4. 4

    Ensure that all necessary parties sign the document.

  5. 5

    Keep a copy of the completed POLST Form with you at all times.

Who needs the Pennsylvania POLST Form Instructions and Guidelines?

  1. 1

    Individuals diagnosed with serious, life-limiting conditions need this form to direct their medical care based on their preferences.

  2. 2

    Patients who have had multiple hospitalizations within a year should use this form to clarify their treatment desires.

  3. 3

    Elderly individuals or those experiencing significant health decline can benefit from the POLST Form to ensure their wishes are respected.

  4. 4

    Legal representatives of patients may need this document to make informed decisions about continued care.

  5. 5

    Caregivers seeking to understand and advocate for their patients' end-of-life wishes require this form for guidance.

How PrintFriendly Works

At PrintFriendly.com, you can edit, sign, share, and download the Pennsylvania POLST Form Instructions and Guidelines along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.

thumbnail

Edit your Pennsylvania POLST Form Instructions and Guidelines online.

On PrintFriendly, editing the PDF is simple and intuitive. Use our PDF editor to modify text within the document easily. Save your edits and download the revised version at your convenience.

signature

Add your legally-binding signature.

Signing the PDF on PrintFriendly is an effortless process. You can electronically sign the document right on the platform. Once signed, you can easily download or share the finalized PDF.

InviteSigness

Share your form instantly.

Sharing your completed PDF on PrintFriendly is straightforward. Utilize the share functionality to send your document via email or through social media channels. Ensure your important healthcare decisions reach the necessary parties promptly.

How do I edit the Pennsylvania POLST Form Instructions and Guidelines online?

On PrintFriendly, editing the PDF is simple and intuitive. Use our PDF editor to modify text within the document easily. Save your edits and download the revised version at your convenience.

  1. 1

    Access the POLST PDF in the PrintFriendly editor.

  2. 2

    Make necessary edits directly by clicking on the text fields.

  3. 3

    Review your changes to ensure accuracy.

  4. 4

    Click the save button to retain the edited document.

  5. 5

    Download or share the updated form as needed.

What are the instructions for submitting this form?

To submit the POLST Form, you can send it directly to your healthcare provider via email or fax. Ensure that all required signatures are complete before submission. Keep a copy of the submitted form for your records and inform your healthcare team of the document’s existence.

What are the important dates for this form in 2024 and 2025?

There are no specific important dates provided for the POLST form as it is utilized based on the patient's current medical situation. However, it is essential to ensure the form is periodically reviewed to reflect any updates in personal health status or preferences.

importantDates

What is the purpose of this form?

The Pennsylvania Orders for Life-Sustaining Treatment (POLST) Form serves the crucial purpose of detailing healthcare preferences for seriously ill patients. It empowers patients to make informed decisions on their end-of-life care, ensuring that their wishes are honored in various medical situations. By utilizing a standardized form, healthcare providers can easily understand and implement the patient's treatment choices.

formPurpose

Tell me about this form and its components and fields line-by-line.

The POLST form includes several key components, carefully designed to capture the patient's healthcare preferences accurately.
fields
  • 1. Patient Information: This section captures the patient's name, date of birth, and contact details for identification purposes.
  • 2. Treatment Preferences: Patients specify their preferences regarding CPR, mechanical ventilation, and other critical care interventions.
  • 3. Signatures: The form requires signatures from the patient and their healthcare provider to validate the orders.
  • 4. Additional Instructions: This component allows patients to provide further instructions or comments related to their care.

What happens if I fail to submit this form?

Failing to submit the POLST Form may lead to uncertain medical decisions during critical times. Without a completed form, healthcare providers might not know the patient's preferences, which could lead to unwanted medical interventions. Ensuring timely submission of the POLST Form is crucial for effective end-of-life care.

  • Unclear Medical Direction: Without the POLST Form, healthcare providers may make decisions that do not align with the patient's wishes.
  • Increased Stress for Family: Families may face additional emotional stress and uncertainty about how to proceed without a clear directive.
  • Potential for Unwanted Treatments: Patients may receive medical treatments against their preferences, leading to distress and conflict.

How do I know when to use this form?

The POLST Form should be utilized when patients wish to clearly communicate their end-of-life care preferences. It is particularly important for those with serious illnesses or declining health to ensure their treatment wishes are understood by healthcare providers. The form is essential following a significant medical diagnosis or any new changes in health status.
fields
  • 1. Serious Illness Diagnosis: Use the POLST Form to articulate treatment preferences after being diagnosed with a serious illness.
  • 2. Change in Health Status: Utilize the form to update or clarify end-of-life wishes following changes in a patient's health.
  • 3. Pre-Hospitalization Planning: Fill out the POLST Form prior to hospitalization to ensure that your treatment preferences are clear.

Frequently Asked Questions

What is the POLST Form?

The POLST Form is a medical order that outlines a patient's preferences for end-of-life care.

Who should fill out the POLST Form?

Patients with serious illnesses or high medical risks should consider completing the POLST Form.

How do I edit the POLST Form?

Use the PrintFriendly editor to modify any content in the POLST PDF easily.

Can I sign the POLST Form electronically?

Yes, PrintFriendly allows you to electronically sign your POLST document.

How do I share my POLST Form?

Easily share your completed form via email or social media through the PrintFriendly platform.

Why is the POLST Form important?

It ensures that healthcare providers honor a patient's treatment preferences during critical medical situations.

What if I change my mind after filling out the POLST Form?

You can update your preferences by revisiting the form and discussing changes with your healthcare provider.

How do I submit the POLST Form?

Follow the instructions for submission outlined in the PrintFriendly site.

Is there a fee to use PrintFriendly?

PrintFriendly services are available for free, allowing users to edit and download PDFs easily.

Can family members help fill out the POLST Form?

Yes, family members can assist in discussing and filling out the POLST Form with the patient.

Related Documents - POLST Instructions

https://www.printfriendly.com/thumbnails/00c3187b-714a-46e1-b838-63cb55d99033-400.webp

Preparticipation Physical Evaluation Form

The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.

https://www.printfriendly.com/thumbnails/0044f6bb-200d-4feb-af5e-5418c7c49f5b-400.webp

Health Insurance Tax Credits Guide 2015

This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.

https://www.printfriendly.com/thumbnails/004d5be1-e317-4428-8e2a-abdae34e3104-400.webp

TSP-77 Partial Withdrawal Request for Separated Employees

The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.

https://www.printfriendly.com/thumbnails/00130a9c-16ca-4288-b930-d1b35cfc98a5-400.webp

Ray's Food Place Donation Request Form Details

This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.

https://www.printfriendly.com/thumbnails/0068df9b-4e3c-483a-b634-e4a14e1ac2d7-400.webp

Pastoral Ministry Evaluation Form for Board of Elders

This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.

https://www.printfriendly.com/thumbnails/006523dd-df32-4387-b7ec-377b657bab81-400.webp

Health Provider Screening Form for PEEHIP Healthcare

This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.

https://www.printfriendly.com/thumbnails/00bd082a-fe2f-430f-9aec-8e73104dc545-400.webp

Common Law Marriage Declaration Form for FEHB Program

This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.

https://www.printfriendly.com/thumbnails/0081b68c-5987-40c0-8165-6c4e6bc8ca16-400.webp

MyPRALUENT™ Enrollment Form Instructions and Details

This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.

https://www.printfriendly.com/thumbnails/0018a923-2651-48d9-a13e-33e539f837c5-400.webp

Application for Certified Copy of Birth Certificate

This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.

https://www.printfriendly.com/thumbnails/00180268-d199-44a7-8663-4a56cc1c8a54-400.webp

Torrance Memorial Physician Network Forms for Patients 18+

This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.

https://www.printfriendly.com/thumbnails/009686d3-b5a9-4a32-8146-5b45159f41f6-400.webp

Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone

This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.

https://www.printfriendly.com/thumbnails/0088f689-5aa6-4002-a99c-c65d49060780-400.webp

Texas Automobile Club Agent Application Form

This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.