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POLST Guidance for Health Care Providers and Professionals
The Illinois Department of Public Health (IDPH) Uniform Practitioner Orders for Life-Sustaining Treatment (POLST) Form can be used to create a practitioner order that reflects an individual’s wishes about receiving cardiopulmonary resuscitation (CPR) and life-sustaining treatments, such as medical interventions and artificially administered nutrition and hydration. It allows an individual, in consultation with his or her health care professional, to make voluntary advance decisions about CPR and other life-sustaining care in the event the individual’s breathing and/or heartbeat stops or based on the patient’s medical condition and preferences.
The IDPH Uniform POLST Form is intended to be honored across various settings, including, but not limited to, hospitals, nursing homes, hospice, and emergency medical services regardless of location.
Properly executed prior versions of the POLST form, such as the IDPH Uniform Do Not Resuscitate (DNR) or the DNR/POLST Advance Directive, are still valid. In addition, health care professionals should honor the National POLST Form and out-of-state forms that are formally authorized by a state or territory within the United States, including Medical Orders for Scope of Treatment (MOST), Medical Orders for Life Sustaining Treatment (MOLST), Physician Orders for Scope of Treatment (POST), or Physician Orders for Life Sustaining Treatment (POLST) forms.
The IDPH Uniform POLST Form should be completed only after detailed discussion about treatment preferences with the individual or with the individual’s legal representative if the individual lacks decision-making capacity. Items for discussion should include the patient’s preferences regarding administration of cardiopulmonary resuscitation (CPR) and life-sustaining treatment, in view of the following:
- The patient’s personal values and goals
- The patient’s medical condition and related medical considerations
- The patient’s views regarding use of CPR in the event of an unforeseen accident (such as a car crash or choking on food)
- The patient’s views on quality-of-life issues before and after CPR
- The patient’s views regarding use of CPR during surgery or other medical procedure
- The patient’s wishes regarding organ donation
- The patient’s views regarding intubation and use and duration of a mechanical ventilator
- The patient’s wishes for life-sustaining treatments, including the use and duration of surgical and non-surgical medically administered nutrition and hydration
A POLST form cannot be required as a condition of an individual’s treatment, care, or admission to a health care facility. POLST orders are always voluntary and may be changed by a patient or their legal representative.
General Considerations
How can the IDPH Uniform POLST Form be obtained?
The form may be downloaded from the IDPH website at https://dph.illinois.gov/topics-services/health-care-regulation/nursing-homes/advance-directives.html.
Are health care providers required to honor a validly completed IDPH Uniform POLST Form, National POLST Form, or authorized out-of-state form?
Yes. Licensed hospitals, certain licensed long-term care facilities, such as nursing homes, and licensed emergency medical services personnel must honor the IDPH Uniform POLST Form, National POLST Form, or authorized out-of-state form, or a copy of that document.
Are photocopies and digital copies of the IDPH Uniform POLST Form, National POLST Form, or authorized out-of-state form valid?
Generally, yes. Digital copies and photocopies, including faxes, on ANY COLOR paper are legal and valid. Each health care facility, however, may have different policies on whether copies of POLST orders completed on a form other than an IDPH Uniform POLST Form are accepted as valid. It is advisable to check with a health care facility regarding its POLST policy.
Completing and Reviewing the IDPH Uniform POLST Form
When is the best time to discuss the form with an individual?
Although it is not always possible, the ideal time for discussion is when the individual is alert and able to fully understand and articulate his or her wishes about end-of-life care.
Who may consent to a POLST order?
Consent may be obtained from the individual or from a person legally authorized to act on that person’s behalf, such as the individual’s legal guardian, agent under a power of attorney for health care, or a surrogate decision maker. A parent or legal guardian typically may consent to a POLST order for a minor.
Emancipated minors also may consent to a POLST order. An “emancipated minor” is a minor who is legally emancipated pursuant to 750 ILCS 30/1, et seq., or married, pregnant, or a parent pursuant to 410 ILCS 210/1, et seq.
Does the IDPH Uniform POLST Form require the signature of the person who is consenting to the POLST order?
Yes. The patient or his or her authorized legal representative must sign the section of the form.
Concerning consent to the POLST order. The rules for the Uniform POLST provide that verbal/phone consent by the patient or legal representative is acceptable. Staff should document this consent on the IDPH Uniform POLST Form according to the documentation policies of the facility or community.
Why does the individual (or their legal representative) and a qualified health care practitioner sign the IDPH Uniform POLST Form?
The law authorizing the development of the form specifies that an individual (or their authorized legal representative) may consent to the IDPH Uniform POLST Form. Because it is a practitioner’s medical order, it requires the signature of a qualified health care practitioner to be legally executed.
Is a witnesses required for the IDPH Uniform POLST Form?
No. The signature of a witness to consent is no longer required by Illinois law.
Is the IDPH Uniform POLST Form valid if the second page of the form has not been completed or is missing?
Yes. A properly completed order should be followed even if the second page of the form has not been completed or is missing. The second page is only for informational purposes.
What if a patient or their power of attorney for health care (POAHC) decides to revoke a POLST order?
An individual or their POAHC can revoke a POLST order. To revoke, draw a line through sections A through E and write “VOID” across the page. Beneath the written "VOID," write in the date of change and re-sign. If included in an electronic medical record, follow all voiding procedures in accordance with organizational practice. The revocation decision also should be communicated to the individual’s health care professionals and providers and to others who should know this information, such as their POAHC, certain family members, or caregivers.
Can a health care surrogate (as defined by the Illinois Health Care Surrogate Act) revoke a POLST order signed by a patient?
Yes, but first the surrogate must assure that it is established that the patient lacks decisional capacity and has no POAHC. Revocation and completion of new POLST orders must occur in consultation with the attending practitioner. The surrogate should be encouraged to use “substituted judgment” based on the patient’s known wishes, including the POLST form signed by the patient. New information known about the patient’s wishes and condition must be documented in the patient’s medical record.
To revoke, the surrogate must draw a line through sections A through E and write “VOID” across the page. Beneath the written "VOID," write in the date of change and re-sign. If included in an electronic medical record, follow all voiding procedures in accordance with organizational practice. The revocation decision also should be communicated to the individual’s health care professionals and providers, and to others who should know this information, such as family members or caregivers.
Implementing a POLST Order on an IDPH Uniform POLST Form
Does the law address the potential liability of a health care provider or professional in connection with implementing a POLST order?
Subsection (d) of Section 65 of the Health Care Surrogate Act, 755 ILCS 40/65, provides:
A health care professional or health care provider may presume, in the absence of knowledge to the contrary, that a completed Department of Public Health Uniform POLST Form, National POLST Form, another state's POLST portable medical orders form, or an out-of-hospital Do Not Resuscitate (DNR) order sanctioned by a state in the United States executed by an adult, or a copy of that form or a previous version of the uniform form, is valid. A health care professional or health care provider, or an employee of a health care professional or health care provider, who in good faith complies with a cardiopulmonary resuscitation (CPR) or life-sustaining treatment order, Department of Public Health Uniform POLST Form, or a previous version of the uniform form made in accordance with this Act is not, as a result of that compliance, subject to any criminal or civil liability, except for willful and wanton misconduct, and may not be found to have committed an act of unprofessional conduct.
Are DNR or POLST orders ever suspended during a surgery or other medical procedure?
POLST orders may be suspended during a surgical or other medical procedure after discussion with the attending practitioner and the individual (or the individual’s authorized legal representative when applicable) according to organizational practices. A patient’s wishes regarding applicability of a POLST order during surgery or in the event of an unforeseen event (such as a car crash or choking on food) may be placed on the IDPH Uniform POLST Form in section C, “Additional Orders or Instructions.”
The Illinois Department of Public Health has provided this guidance for general informational purposes. Because each individual situation is different and key facts can so often change the outcome, additional questions should be directed to a licensed attorney, as IDPH cannot provide legal advice.