6 Steps to Get, Complete, and Store a POLST in Washington

In Washington, a POLST is a clinician-signed set of portable medical orders for people with serious illness or advanced frailty. If that describes you or someone you’re caring for, the next step is straightforward: ask your clinician for the Washington POLST form, or request one through your health system before your next appointment.

TL;DR:

A POLST, short for Portable Orders for Life Sustaining Treatment, is a medical order signed by a clinician that travels with a patient across care settings, from home to hospital to adult family home. Unlike a standard Do Not Resuscitate order , which addresses resuscitation only, a POLST covers multiple treatment categories including resuscitation, medical interventions, antibiotics, and artificial feeding.

That breadth is what separates a POLST from a DNR, and it’s also what separates it from an advance directive. An advance directive is a legal document, typically a living will or a Durable Power of Attorney for Health Care, that names a health care agent and records general wishes for future care. A POLST is a medical order that applies right now, based on a patient’s current health status. The two documents aren’t competitors. An advance directive names who speaks for a patient and outlines broad values; a POLST translates those values into specific, actionable orders that a paramedic or an emergency room physician can follow immediately.

A POLST isn’t meant for every adult. It’s designed for people with serious illness or advanced frailty, not for otherwise healthy people planning for a hypothetical future. That’s what an advance directive is for. Clinicians often use a simple gut check to decide when a POLST conversation is warranted: would you be surprised if this patient died within the next year or two? If the honest answer is no, it’s time to talk.

That conversation works best as shared decision-making, not a form to sign quickly at checkout. Washington requires a clinician signature (an MD, DO, ARNP, or PA-C) for the form to carry medical authority, and that signature should follow an actual discussion about goals, prognosis, and tradeoffs. If the patient lacks decision-making capacity, the legal medical decision-maker, whether that’s a health care agent named in an advance directive or a court-appointed guardian, needs to be part of that discussion and typically signs in the patient’s place.

Pro Tip: If you’re not sure whether the timing is right, ask your primary care provider directly: “Given my current health, would a POLST make sense for me?” Most clinicians welcome that question rather than waiting for you to raise it after a crisis.

The official form covers categories including resuscitation, medical interventions, antibiotics, and artificial feedings, each with specific treatment instructions for emergency responders and hospital staff.

One detail surprises a lot of families: choosing “comfort measures only” or declining a specific intervention never means declining care altogether. DOH’s guidance is explicit that pain management, wound care, and other comfort-focused treatment continue regardless of what’s marked elsewhere on the form.

Why the paper matters: WSMA recommends printing the English-language form on bright green card stock, which is the version emergency responders are trained to recognize on sight. Photocopies and digital images of a properly signed form are still valid. Unofficial “pocket” summary versions are not.

Getting a POLST typically takes one clinical appointment and a filing system that actually works in an emergency. Here’s the practical sequence.

Revoking a POLST is deliberately simple: a patient or decision-maker can verbally revoke it, destroy the document, or write “VOID” across it in large letters. Clinicians updating a POLST should always complete a new form rather than editing the old one.

A valid Washington POLST needs five things: the patient’s full name, date of birth, the patient or legal decision-maker’s signature and date, and the clinician’s signature and date. Every one of those elements can appear on a photocopy, scanned image, or fax, according to DOH’s POLST guidance for EMS providers and it’s still treated as fully valid.

The National POLST Collaborative pushes for consistency across states, but each state still adopts and implements its own version. If you’ve recently moved to Washington from another state, the safest move is completing a new Washington form rather than assuming your old one transfers cleanly.

A little preparation turns a rushed clinical conversation into a useful one. Bring a current medication list, any recent hospital discharge summaries, and a copy of your advance directive or health care power of attorney so your clinician has the full picture.

Come with real questions: How would each choice affect a transfer to the hospital? What does “comfort measures only” mean for a serious infection? Would declining antibiotics change eligibility for hospice care? These aren’t small details. They’re exactly what shapes how the form gets filled out.

Plan to revisit the POLST regularly, such as after major changes in health or care setting, to ensure it matches current wishes.

Pro Tip: Bring a trusted family member or advocate to the appointment. Someone focused on listening and taking notes catches details the patient might miss in an emotionally difficult conversation.

Families weighing a move to a smaller, more personal care setting after these conversations can browse Washington’s licensed adult family homes directly through Afhcircle, comparing license status and inspection history without a referral fee attached. For those specifically in the Seattle area, Seattle adult family home listings show current openings and care specialties side by side, and the cost and Medicaid guide covers how payment options factor into that decision.

The Washington POLST form gets treated like a checkbox exercise more often than it should. That’s backwards. The document itself is just paper, green stock and all, until it reflects an actual conversation about what a patient wants when their health takes a serious turn. A form signed in five minutes because a hospital discharge planner needed one filled out doesn’t serve anyone well, and it can lead to care that contradicts what the patient actually wanted.

What gets underestimated is how often families assume an advance directive already covers this ground. It doesn’t, not in a way EMS can act on at 2 a.m. A health care agent named in a power of attorney document is enormously useful for big-picture decisions, but a paramedic standing in your living room needs a signed medical order, not a legal appointment. Washington built the POLST system specifically to close that gap, and the state’s insistence on a patient signature, stricter than some neighboring states, exists precisely because that signature is the clearest evidence the choices reflect the patient’s actual voice.

The most overlooked part of this whole process isn’t the signing. It’s the annual review. Health changes, care settings change, and a POLST completed during a hospital stay two years ago may no longer match what a patient would choose today. Treat the form as a living document tied to an ongoing conversation with your clinician, not a one-time task to cross off a list.

— DanMic

This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.

Talk with your clinician about a POLST, then complete the official green form together; it’s also downloadable through WSMA or DOH, though it requires a clinician’s signature to become valid.

No. A DNR addresses resuscitation only, while a POLST covers resuscitation, medical interventions, antibiotics, and artificial nutrition in one document.

No. An advance directive is a legal document naming a health care agent and recording general wishes, while a POLST is a clinician-signed medical order that applies to current, specific treatment decisions.

A POLST and a living will serve different functions rather than overriding each other; the POLST translates the values expressed in a living will or advance directive into specific medical orders that clinicians and EMS can act on immediately.