POLST Guidance for Individuals

The IDPH Uniform POLST form is a medical order that communicates a patient’s advance decisions about CPR and life-sustaining treatment. It is appropriate for a person with a serious or life-limiting illness that is at risk of a life-threatening medical emergency. It is completed voluntarily by a patient (or their legal representative, when applicable) and their health care practitioner after detailed discussion about treatment preferences.

The POLST form allows people to express more specific directions about their health care treatments compared to other advance directives alone and it is used by health care professionals as a standard way to understand a patient's preferences about these treatments.

People who have serious, progressive illness including frailty who are nearing the end of their life should consider completing a POLST form. As well as, people who do not want to receive CPR based on their preferences.

CPR refers to medical procedures that are used in an attempt to restart a person’s heartbeat when they have no pulse. These treatments include but are not limited to chest compressions, electrical shocks, insertion of a breathing tube into the throat, and IV medications, among other things.

Generally, it means a person’s heart is not pumping blood to their body. Without blood flowing in the body, a person has no pulse, becomes unconscious, and will die unless CPR is attempted. Health care professionals may use the medical term “cardiac arrest” to describe this.

When a person has no pulse, health care professionals ordinarily will attempt CPR by default to try to restart the person’s heartbeat. CPR does not always work and often has limited success when initiated outside of the hospital. If successful, CPR can have negative side effects and result in outcomes that are unacceptable to some people.

People have the right to refuse medical treatment and may choose not to receive CPR. Selecting “NO CPR: Do Not Attempt Resuscitation (DNAR)” on the POLST form means that in the event the person has no pulse CPR will not be performed.

An adult, an emancipated minor, or a legal decision maker of any adult or any minor may complete a POLST form.

Life-sustaining treatment can be medical interventions focused on sustaining (artificial airways and mechanical ventilations), selective treatment (IV fluids, medication or comfort measures which allow for natural death (pain medication, wound care, oxygen, suction) and/or artificially administered nutrition by tube.

According to the Illinois Health Care Surrogate act, “life-sustaining treatment means any medical treatment, procedure, or intervention that, in the judgment of the attending physician, when applied to a patient with a qualifying condition, would not be effective to remove the qualifying condition or would serve only to prolong the dying process. Those procedures can include, but are not limited to, assisted ventilation, renal dialysis, surgical procedures, blood transfusions, and the administration of drugs, antibiotics, and artificial nutrition and hydration.”

To get a copy of the IDPH Uniform POLST form a person may request one from their health care practitioner or health care facility. Forms may be downloaded from the IDPH website at: https://dph.illinois.gov/topics-services/health-care-regulation/nursing-homes/advance-directives.html. POLST forms should only be completed after detailed discussion with a qualified health care practitioner.

Patients may receive a form when being admitted to a skilled nursing or long-term care facility (such as a nursing home). The POLST form is voluntary and cannot be required for admission to a facility or to receive care.

When valid and present, POLST form orders should be honored in Illinois by licensed hospitals, in licensed long-term care facilities such as nursing homes, and in the community by emergency medical services personnel. This one form travels with the patient to different health care settings and can easily be used by the health care professionals in that setting.

No. In the absence of a POLST form, CPR should be attempted if a person has no pulse, and all life-sustaining treatments will generally be attempted.

Because the form can be used to indicate acceptance, not just refusal, of certain medically indicated treatments, and unfortunately, many patients with disabilities experience bias resulting in under-treatment and/or have their chronic health conditions mistaken for illnesses as they near the end of life, use of the form to select “YES CPR” may be appropriate based on the person's health condition as a way to reduce having inaccurate assumptions made about their acceptance of CPR.

No. If “YES CPR” is selected in section A on the POLST form, then only “Full Treatment” in section B can be chosen.

CPR and life-sustaining treatment should generally be attempted.

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.

Yes. A patient or their authorized legal representative, as appropriate, must print and sign their name in the section of the form concerning consent.

Electronic signature is acceptable under certain conditions. Patients can check with their health care provider.

No. The Signature of a Witness to Consent is no longer required by Illinois law and it has been removed from the POLST form.

During an emergency when the POLST form is completed and present (i.e. in a patient’s medical record) and the patient cannot speak for themselves at that time and/or has no pulse they will receive (or have withheld) the life-sustaining treatment as chosen on the form.

If the patient can speak for themselves in the moment, then they are spoken with about the medical care they want to be given at that time and may ask for or decline care that differs from what is on their POLST form. If a legal representative is speaking on the patient’s behalf, when appropriate, and wants to make care choices that differ from what is on the patient’s POLST form, these decisions should reflect what the patient would want according to their values and goals.

Illinois licensed hospitals, certain Illinois licensed long-term care facilities such as nursing homes, and Illinois licensed emergency medical services personnel are required by law to honor an IDPH Uniform POLST form.

Yes, as long as someone provides emergency medical services personnel with a copy of the POLST order form, and the order appears to be valid.

Older versions of the POLST form such as the IDPH Uniform DNR or the DNR/POLST Advance Directive will still be followed. 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) form.

Generally, the POLST form is followed when the patient has no pulse or needs medical care regardless of the cause or in all circumstances. For example, if a person is in an accident, and has no pulse (cardiac arrest), their wishes as stated on the POLST form should be followed by health care professionals and EMS if they are aware of and have the POLST form.

If there are specific situations where a person wants something differently, for example in an auto accident or during a medical procedure such as surgery, this should be discussed with a health care professional. The space named “Section C: Additional Orders or Instructions'' can be used to describe these situations.

It is very important for a person to discuss their wishes with those who care for them and/or their legal representative.

No. POLST forms do not have an expiration date. They should be reviewed occasionally such as when the person has a new diagnosis, a change in health, or moves to a nursing home.

A patient (or their legal representative on their behalf when appropriate) can change the POLST form. The POLST form can be revoked in a variety of ways, such as by writing “VOID” in large letters across the first page of the form and beneath the written “void” write in the date of the change and re-sign, or destroying the form and all copies. If a person revokes POLST form, they should immediately tell their health care professionals, those who care for them, and/or their legal representative. It is also important for the person's medical record to be updated. A person may then decide if they want to complete a new form or not.

Yes. The POLST form, or a copy of it, should go with the person to the next setting, whether it is a hospital, rehabilitation facility, nursing home or their own home.

Generally, photocopies of a valid IDPH Uniform POLST Form are followed.

A person should keep their POLST form with them where they live. They may wish to post a copy of the POLST form in their home in an easy to find place where it will be quickly seen by emergency medical services personnel such as on the refrigerator.

Their practitioner should also keep a copy in the person’s medical record. A legal guardian, agent under a power of attorney for health care, or a surrogate (substitute) decision maker, should have a copy of the POLST form they can get to easily. A copy also should go with the person if they are transported to a hospital or other health care facility such as a rehab facility or nursing home.

Certain health care providers and facilities in Illinois have policies that say a POLST form may be suspended (not followed) during a surgical procedure after discussion with the person or their authorized legal representative.

Before surgery or other medical procedures, a person and their health care professional should discuss why the surgery is being done. There may be a higher risk the person might need CPR or other emergent care during it because of things like anesthesia. Together they should agree on what will happen during this time. The decision can be put in the person’s medical record. A new POLST form does not need to be made for these temporary situations.

A person may choose to make their wishes known or choose someone to speak for them by completing a Power of Attorney for Health Care (POAHC) form or a Living Will form. These are called advance directives.

A person can learn about advance directives and get the forms on the IDPH “Advance Directive” website at https://www.dph.illinois.gov//topics-services/health-care-regulation/nursing-homes/advance-directives#publications.

Forms on the IDPH “Advance Directives” website include: the Illinois Department of Public Health Uniform POLST, the Power of Attorney for Health Care, the Living Will Declaration, and the Declaration for Mental Health Treatment.