POLST Hawaii: How to Complete the Form and What It Means for Your Parent

Your parent is about to be discharged from the hospital, and the social worker hands you a bright lime-green form titled "POLST." She says it is "important" but does not explain how it differs from the advance directive your parent signed three years ago, or what happens if the paramedics cannot find it during an emergency.

A POLST — Provider Orders for Life-Sustaining Treatment — is not a planning document. It is an active medical order that takes effect immediately upon signature. Unlike an advance directive, which expresses future wishes, a POLST tells first responders exactly what to do right now.

What Makes the POLST Different from an Advance Directive

An Advance Health Care Directive (AHCD) under HRS Chapter 327E lets your parent designate a health care surrogate and express preferences about end-of-life treatment. It is a planning document that guides future decisions.

A POLST is an actionable medical order. The key differences:

A POLST does not replace an AHCD. Your parent should have both. The AHCD designates who makes decisions. The POLST tells clinicians what those decisions are, in a format emergency responders can act on in seconds.

Who Can Sign a Hawaii POLST

A Hawaii POLST must be signed by:

1. A healthcare provider licensed in Hawaii — a physician (MD or DO), Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA)
2. The patient — or their legally recognized health care surrogate if the patient lacks capacity

The patient's family members cannot sign the POLST on their own authority unless one of them holds a valid health care surrogate designation under the parent's AHCD or has been appointed as guardian.

The Lime-Green Paper Rule

Hawaii recommends printing the POLST on lime-green paper so it is immediately visible to EMS personnel and transport crews. A black-and-white copy is legally valid, but green paper cuts critical seconds in an emergency when paramedics need to locate the form quickly.

Keep the original in a visible, standardized location — typically on the refrigerator door (inside a clear plastic sleeve) or immediately inside the front door. If your parent moves between home and a care facility, the POLST travels with them.

Sections of the Hawaii POLST

The form covers four treatment categories:

• Section A — Cardiopulmonary Resuscitation (CPR): Full CPR attempts or Do Not Attempt Resuscitation (DNAR)
• Section B — Medical Interventions: Full treatment (ICU, intubation), selective treatment (IV fluids, cardiac monitoring but no intubation), or comfort-focused treatment only
• Section C — Artificially Administered Nutrition: Full tube feeding, trial period, or no artificial nutrition
• Section D — Antibiotics: Full treatment, limited treatment (oral only), or comfort measures only

Each section is independent. A parent can choose DNAR in Section A while requesting full antibiotics in Section D. The form reflects the patient's specific values, not an all-or-nothing choice.

Revoking or Changing a POLST

A patient with capacity — or their legally designated surrogate — can revoke or modify a POLST at any time. To formally void the form:

1. Draw a line through Sections A through D
2. Write "VOID" in large letters across the page
3. Sign and date the voided form

A verbal revocation to a healthcare provider also works if the patient clearly communicates their intent to change the order.

Why This Matters at Hospital Discharge

If your parent is transitioning home or to a care facility after a hospital stay, the POLST conversation should happen before discharge. The hospital physician can sign the form based on a conversation with your parent about their treatment preferences.

Without a POLST, EMS personnel arriving at a 911 call will default to full resuscitation — even if your parent has an AHCD expressing a preference against it. The AHCD requires interpretation. The POLST does not.

For guidance on completing the POLST alongside other discharge documents — including the AHCD, financial power of attorney, and the DHS 1147 level-of-care evaluation — the Hospital-to-Home Hawaii guide walks through each form with Hawaii-specific instructions.

See more Hawaii guides →