Montana POLST Form

What a POLST Form Does in Montana

A POLST (Provider Orders for Life-Sustaining Treatment) is a medical order — not a planning document. In Montana, it translates a patient's treatment preferences into specific medical orders that EMS, hospital staff, and other health-care professionals use in an emergency. The form covers CPR status, the level of medical intervention desired (from comfort measures only through full treatment), and whether the patient wants artificially administered fluids and nutrition.

The distinction from an advance directive is practical and matters during an emergency. An advance directive expresses general preferences and only takes effect when a person can't communicate. A POLST is an active medical order signed by a physician or advanced practice provider that governs treatment right now. Paramedics responding to a 911 call at your parent's home will follow the POLST — they are not trained or authorized to interpret advance directive language in real time.

Who Needs a POLST and When

Montana does not require every senior to have a POLST. The form is designed for people with serious illness or frailty whose treatment preferences need to be available during an emergency. For an aging parent receiving home care through Medicaid waiver programs, the clinical circumstances that typically trigger a POLST conversation include:

• A progressive dementia diagnosis where the parent can no longer reliably communicate treatment preferences
• A recent hospitalization for a fall, stroke, or cardiac event that signals declining baseline function
• A nursing facility level of care (NFLOC) determination by Mountain-Pacific Quality Health, which by definition means the parent requires institutional-level support

If your parent is in early-stage decline and can clearly articulate their wishes, an advance directive and a healthcare power of attorney may be sufficient. The POLST becomes essential when their condition has progressed to the point where emergency responders need unambiguous standing orders.

How to Complete the Montana POLST

The form itself is a single double-sided page printed on terra green (light lime green) paper. Here is the process:

Start the conversation with the treating physician. The POLST must reflect the patient's informed preferences after a discussion with a qualified healthcare provider. In Montana, a physician (MD or DO), nurse practitioner, or physician assistant can sign the form. A family member cannot complete or sign it merely because they are family; a legal decision-maker, medical power of attorney, or legal guardian may sign the decision-maker section when authorized.

Complete each section. Section A covers CPR instructions (attempt resuscitation or do not attempt). Section B covers the level of medical intervention: comfort measures only, limited additional interventions (such as IV fluids and cardiac monitoring but not intubation), or full treatment. Section C addresses artificially administered nutrition — whether to provide long-term feeding tubes or IV nutrition, or to offer only comfort feeding by mouth.

Sign and distribute. The physician signs the form, the patient or their authorized representative signs the consent section, and the original goes to the patient (kept in the home, typically posted on the refrigerator or next to the front door). A copy goes into the medical record, and another copy should travel with the parent to any hospital visit, rehab stay, or transport.

POLST vs. Advance Directive vs. DNR

These three documents overlap in purpose but operate in different legal lanes in Montana:

An advance directive (including a living will) is a planning document under Montana's Rights of the Terminally Ill Act. It applies if the person has an incurable or irreversible terminal condition that, in the attending physician's or APRN's opinion, will cause death within a relatively short time and the person can no longer make medical decisions; the declaration is witnessed by two individuals.

A Do Not Resuscitate (DNR) order is a medical order but covers only CPR — it says nothing about ventilators, feeding tubes, or levels of hospital intervention.

A POLST is the most comprehensive medical order. It covers CPR, level of intervention, and nutrition preferences. It is active immediately upon signing and applies across all care settings — home, ambulance, ER, hospital, and nursing facility.

For an aging parent receiving home care in Montana, having both an advance directive and a POLST provides the most complete coverage. The advance directive handles scenarios the POLST doesn't address (organ donation preferences, appointment of a healthcare agent). The POLST gives first responders clear, actionable orders.

The Montana Home Care Navigation Guide includes a section on establishing legal and medical authority for an aging parent, covering the full sequence: durable financial power of attorney, medical power of attorney, advance directive, and POLST — with a checklist for when each document is needed and who needs copies.

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