POLST Form Oregon

A POLST — Physician Orders for Life-Sustaining Treatment — is a medical order, not a legal planning document. Signed by a licensed clinician based on the patient's preferences, it tells paramedics and emergency room staff exactly what interventions to use or withhold during a medical crisis. In Oregon, the POLST travels with the patient across care settings, and emergency responders are trained to look for it.

What the POLST Covers

The Oregon POLST form addresses three categories of emergency medical intervention:

Section A — Cardiopulmonary Resuscitation (CPR). If the patient has no pulse and is not breathing, should responders attempt CPR? The choices are "Attempt Resuscitation" or "Do Not Attempt Resuscitation." This section applies only when the patient is in full cardiac or respiratory arrest.

Section B — Medical Interventions. This covers the level of treatment when the patient has a pulse but is experiencing a serious medical emergency. Options range from full intervention (intubation, mechanical ventilation, ICU transfer) through selective treatment (IV fluids, cardiac monitoring, but no intubation) to comfort-focused treatment only.

Section C — Medically Administered Nutrition. Whether to provide nutrition through a feeding tube if the patient cannot eat by mouth. Options include a trial period, long-term use, or no artificial nutrition.

POLST vs. Advance Directive — When You Need Both

The advance directive is the planning document. Signed while the patient has capacity, it appoints a Health Care Representative and records treatment preferences for future reference. The health care representative uses it to guide decisions during sustained incapacity.

The POLST is the execution document. It translates those preferences into standing medical orders that first responders act on immediately, without calling a health care representative or consulting hospital records.

Most families managing a parent's progressive decline need both. The advance directive governs hospital admission decisions, facility placement choices, and longer-term treatment planning. The POLST governs what happens in the first minutes of a cardiac arrest or acute medical crisis.

Who Can Sign and When to Update

A physician, nurse practitioner, or physician assistant must sign the POLST medical orders. Unlike the advance directive, there are no witness requirements.

A POLST should be reviewed and potentially updated whenever the patient's condition changes significantly — after a hospitalization, a new diagnosis, a move to a different care setting, or any shift in treatment goals. Either the patient or the clinician can void or revise the form at any time.

The Practical Gap Most Families Miss

Many families complete a POLST during a hospital admission and assume their emergency planning is done. But the POLST does not appoint anyone to make medical decisions. If the patient loses capacity and has no advance directive naming a health care representative, the family must petition for guardianship under ORS Chapter 125 — a process that costs $4,500 or more in legal fees and takes weeks to complete.

The POLST handles the emergency. The advance directive handles the decision-maker. The durable power of attorney handles the finances. All three documents work together, and all three should be completed before a crisis forces the issue.

Connecting the Documents to the Bigger Picture

Emergency medical orders are one part of a care planning process that includes understanding Oregon's care settings, Medicaid qualification rules, and the CAPS functional assessment. Our Oregon care decision guide walks through the complete sequence so each piece — legal authority, facility selection, financial eligibility — connects to the next.

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