POLST and MOLST forms — medical orders that travel with the patient
Reviewed by a licensed elder law educator | Updated March 2026
A POLST or MOLST form is a medical order that tells emergency responders and hospital staff exactly what treatments your parent does and does not want. Unlike a living will, it requires no interpretation. It travels with your parent between care settings and overrides default hospital protocols, making it one of the most actionable end-of-life planning tools available.
A POLST Form Is a Doctor's Order, Not a Wish List
Your father has been declining for months. His dementia is progressing. He has heart disease. He's in a nursing home, and everyone involved in his care knows that he's approaching the end of his life. The conversations with his doctors have been about comfort, not cure. But last week he aspirated some food and developed pneumonia. The nursing home called an ambulance. He was admitted to the hospital. Once there, he was treated aggressively: antibiotics, supplemental oxygen, constant monitoring. He was scared and confused. Three days later, once the acute crisis was managed, the hospital contacted you asking what to do next.
This scenario plays out in hospitals across the country because there's a gap between what people want at the end of their lives and what actually happens. People say they want comfort care. They say they don't want to be on machines. But the moment they go to the hospital with an acute problem, the hospital treats it as an acute problem. That's what hospitals do. Unless there's a very specific document in place, hospital staff will treat the acute event, not respect the person's overall wishes.
That document is called a POLST form in some states and a MOLST form in others. POLST stands for Physician Orders for Life Sustaining Treatment. MOLST stands for Medical Orders for Life Sustaining Treatment. Some states call it MOST, COLST, or something similar. The acronyms vary, but they all refer to the same type of document: a medical order that provides specific directions about what treatments your parent wants and doesn't want. According to the National POLST organization, POLST programs now operate in 48 states plus the District of Columbia, though the specific forms, names, and legal requirements differ by state.
Here's the difference that matters. A living will is a statement of values and wishes. It's written in language like "if I'm in a persistent vegetative state, I don't want life support." A POLST form is a doctor's order. It has checkboxes. It says specifically what will and won't be done. It says "no CPR" or "yes CPR" or "CPR only if a sudden event." It says whether the person wants antibiotics for infection or not. It says whether they want artificial nutrition or not. It says whether they want hospitalization or not. A living will needs to be interpreted. A POLST form doesn't. Research published in the Journal of the American Geriatrics Society found that POLST forms are significantly more effective than traditional advance directives at ensuring patients' end-of-life wishes are followed, with one study showing POLST orders were honored in over 90 percent of cases.
Because it's a medical order, it's more portable than other documents. Many states require POLST forms to be printed on bright pink or yellow paper so paramedics can see them immediately. A nursing home that admits your parent should check for a POLST form. Hospitals should check for one on admission. If your parent is at home and calls 911, paramedics will look for one.
The POLST form is meant for people who are seriously ill, are near the end of life, or have advanced chronic illness. A healthy sixty-year-old with no serious health conditions doesn't need one. A ninety-five-year-old with metastatic cancer and heart failure should have one. A person with advanced dementia who's declining should have one. The form is for people for whom death in the foreseeable future is realistic.
How It Gets Completed and Who Signs It
Your parent's physician completes the POLST form with your parent (if possible) or with you as their decision-maker. The physician evaluates your parent's current health, discusses what treatments make sense given that health status, and documents the choices. The form covers specific domains: whether your parent wants CPR, whether they want hospitalization, whether they want artificial nutrition and hydration, and what the overall goals of care are.
The form needs to be signed by your parent if they have capacity, and it needs to be signed by the physician. This is what makes it an order. It's not just your parent's wishes. It's the physician's assessment of what's appropriate combined with what your parent wants. The form then travels with your parent. If your parent moves between care settings, the form moves too. If your parent goes to the hospital, the form should go to the hospital. Paramedics who see the form will follow its directions.
Your parent can revoke the form at any time. If they change their mind, they can ask for a new one. The most recent form is always the one that applies.
The conversation about a POLST form is more concrete than the conversation about a general advance directive. With an advance directive, you might talk about values. With a POLST form, you're talking about specific treatments. Does your parent want antibiotics if they get pneumonia? Does your parent want to be admitted to the hospital if they have an acute problem? Does your parent want artificial nutrition if they can't eat? These are specific, medical questions. Some people find these easier to answer than abstract questions about values. Others find them harder because they're so specific.
Your parent should be involved in these decisions if they can be. If your parent is alert and can express their wishes, they should. If your parent has already lost capacity, you'll be making these decisions as their surrogate. If your parent still has capacity but it's declining, this is another conversation to have sooner rather than later.
Making It Work in Practice
Talk with your parent's physician. If your parent is seriously ill or near the end of life, bring it up directly. Say something like, "We've been thinking about my mother's medical values. Should we be talking about a POLST form?" The doctor can assess whether it's appropriate and initiate the conversation. The AARP recommends that any person with a serious illness discuss POLST forms with their physician as part of a comprehensive advance care planning process.
If your parent is still capable of expressing their wishes, they should be the one talking to the doctor. If your parent has lost capacity, you'll be doing this as their surrogate, and you'll want to make decisions based on what you know about their values. A person with advanced dementia who loves being outside and enjoys music might want antibiotics to treat an infection so they can continue to have those experiences. A person with advanced cancer who's in pain might want comfort care only. There's no right answer. There's just your parent's answer.
Once the POLST form is completed and signed, it needs to be distributed. Copies should be posted at your parent's home, in their medical chart, in the nursing home's records if applicable. Your parent should carry a copy if possible. Some states have registries where POLST forms can be registered so that paramedics can look them up electronically. Check with your state's POLST program to see if a registry is available.
Where your parent is living matters too. If your parent is in a nursing home, the nursing home usually has processes for discussing POLST forms and having them completed. If your parent is at home, you may need to work with their physician to get one completed. If your parent is in the hospital, the hospital can initiate the conversation and complete the form before discharge.
This is one of those documents where you're not trying to control your parent's medical situation. You're trying to honor what your parent actually wants. You're trying to make sure that when your parent is sick and scared and can't advocate for themselves, their wishes are being followed, not overridden because hospital protocol says to treat the acute problem. The POLST form works best as part of a comprehensive advance care planning process alongside a healthcare power of attorney and an advance directive. It's the actionable piece, the piece that tells paramedics what to do when there are seconds to decide. Having it in place for a seriously ill parent is not preparing for their death. It's preparing for their care to actually reflect what they want.
Frequently Asked Questions
What is the difference between a POLST form and a living will?
A living will is a general statement of values that requires interpretation by a physician. A POLST form is a medical order with specific checkboxes that tells emergency responders and hospital staff exactly what to do. A living will says what you want in broad terms. A POLST form tells medical professionals precisely which treatments to provide and which to withhold, and it carries the force of a doctor's order.
Does my parent need a POLST form if they already have an advance directive?
If your parent is seriously ill or approaching the end of life, yes. Most general advance directives are not specific enough to guide emergency medical decisions, and they are not as portable or immediately actionable as a POLST form. The two documents work together, but they serve different functions.
Can a POLST form be changed after it's signed?
Yes. Your parent can revoke or update the form at any time. A new form can be completed with their physician whenever their wishes or medical situation changes. The most recent form always takes precedence.
Who can sign a POLST form if my parent has lost capacity?
If your parent lacks capacity, their legally designated healthcare surrogate or the person named in their healthcare power of attorney can participate in completing the form with the physician. The physician still signs the medical order.
Is a POLST form valid in every state?
POLST programs operate in 48 states plus the District of Columbia, but the specific forms, legal names, and requirements differ by state. A POLST form completed in one state may not be automatically honored in another. If your parent travels or moves between states, check whether the new state will recognize the existing form or whether a new one is needed.
Where should we keep the POLST form?
Keep copies wherever your parent receives care or might receive care: posted visibly at home (many families use the refrigerator), in their medical chart, in the nursing home file, and with you. If your state has a POLST registry, register the form there so paramedics can access it electronically.