Practitioner Orders for Life-Sustaining Treatment (POLST)


Practitioner Orders for Life Sustaining Treatment Governor Christie signed legislation in 2011 that enabled patients to indicate their preferences regarding life-sustaining treatment through the Practitioner Orders for Life Sustaining Treatment (POLST) form. This form, signed by a patient’s attending physician or advanced practice nurse, provides instructions for health care personnel to follow for a range of life-prolonging interventions. This form becomes part of a patient’s medical records, following the patient from one healthcare setting to another, including hospital, nursing home or hospice.

Pursuant to P.L. 2011, c. 145, the Institute for Quality & Patient Safety Organization was designated as the Lead Agency for Physician Orders for Life-Sustaining Treatment Act.

Below is a copy of the NJ POLST form with an available download link. Please make sure to print this form in color.

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