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

Your parent's advance health care directive says what they want. A POLST form turns those wishes into a medical order that paramedics, nurses, and ER doctors follow immediately — no interpretation required, no waiting for a healthcare agent to answer the phone.

POLST stands for Physician Orders for Life-Sustaining Treatment. In California it's governed by Probate Code Sections 4780–4786 and printed on bright pink paper so first responders can spot it fast during an emergency.

Who Needs a POLST Form

A POLST is designed for people with serious illness or advanced frailty — not healthy adults doing routine estate planning. Your parent likely needs one if they:

• Have been diagnosed with a life-limiting condition (advanced cancer, late-stage COPD, end-stage heart failure)
• Are in a skilled nursing facility or residential care facility
• Would not be surprised to need emergency medical services within the next year
• Have specific wishes about CPR, intubation, or artificial nutrition they want honored immediately

A POLST complements an advance health care directive — it doesn't replace it. The AHCD appoints a healthcare agent and covers broad treatment preferences. The POLST translates specific preferences into binding medical orders across all care settings.

What the California POLST Form Covers

The form has four sections that address the most critical emergency decisions:

Section A — Cardiopulmonary Resuscitation (CPR): Whether to attempt CPR if the person's heart stops or they stop breathing. This is the only section that applies when the person has no pulse or isn't breathing.

Section B — Medical Interventions: The level of treatment preferred when the person still has a pulse — full treatment (ICU, intubation, mechanical ventilation), selective treatment (IV fluids, cardiac monitoring, but avoid intubation), or comfort-focused treatment only.

Section C — Artificially Administered Nutrition: Whether to provide feeding tubes or IV nutrition if the person can't eat or drink on their own.

Section D — Signatures: Both a licensed medical provider (physician, nurse practitioner, or physician assistant) and the patient or their legally authorized surrogate must sign.

How to Get a POLST Signed in California

The POLST isn't a form you download and fill out at home. It requires a conversation between your parent (or their healthcare agent) and a qualified medical provider:

1. Request a POLST conversation with your parent's physician, nurse practitioner, or physician assistant
2. Discuss treatment preferences — the provider explains the medical realities of each option for your parent's specific condition
3. The provider completes the form based on the shared decision-making conversation
4. Both parties sign — the provider and your parent (or their legal surrogate if your parent lacks capacity)
5. Keep the original at home in an obvious location — on the refrigerator door or near the front entrance where paramedics will look first

If your parent is in a skilled nursing facility, the facility should keep the original in the medical chart and give you a copy. California requires that the POLST travel with the patient during any transfer between facilities.

POLST vs. Advance Health Care Directive: Key Differences

Many families confuse these two documents. They serve different purposes:

An AHCD is signed by your parent alone (with witnesses or notarization) and appoints someone to make healthcare decisions when your parent can't. It stays in effect indefinitely unless revoked.

A POLST is a medical order signed by both a provider and your parent. It gives specific treatment instructions that medical personnel follow immediately. It should be reviewed whenever your parent's condition changes, they're admitted to or discharged from a facility, or their treatment preferences evolve.

A parent with moderate dementia who can no longer sign an AHCD may still be able to participate in a POLST conversation if they can express treatment preferences with their provider's guidance. If they can't, their appointed healthcare agent under an existing AHCD can authorize the POLST on their behalf.

When to Update or Void a POLST

A POLST should be reviewed at least once a year or whenever your parent's health status changes significantly. Any of these events should trigger a new POLST conversation:

• A new serious diagnosis
• A hospitalization or significant decline
• Transfer to a different level of care (home to SNF, or SNF to home)
• A change in treatment preferences

Your parent can void the POLST at any time by telling their provider. A provider can also void a POLST if they believe the current orders no longer reflect appropriate care. The voided form should be marked and a new one completed.

Getting Your Parent's Legal Authority in Place

A POLST handles emergency medical orders, but your parent also needs a durable power of attorney for finances and an advance health care directive to cover the full range of decisions you'll face. The California Power of Attorney & Guardianship Kit walks you through every document — what to sign, who needs to witness it, and how to handle banks, Medi-Cal, and IHSS once the paperwork is done.

See more California guides →