IDPH Uniform Practitioner Order For Life-Sustaining Treatment (POLST) Form | Pdf Fpdf Docx | Illinois

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IDPH Uniform Practitioner Order For Life-Sustaining Treatment (POLST) Form | Pdf Fpdf Docx | Illinois

Last updated: 10/17/2023

IDPH Uniform Practitioner Order For Life-Sustaining Treatment (POLST) Form

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IDPH UNIFORM PRACTITIONER ORDER FOR LIFE-SUSTAINING TREATMENT (POLST) FORM. For patients: Use of this form is completely voluntary. If desired, have someone you trust with you when discussing a POLST form with a health care professional. For health care providers: Complete this form only after a conversation with the patient or the patient’s representative. The POLST decision-making process is for patients who are at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty. With significant change in condition, new orders may need to be written. Use of the Illinois Department of Public Health (IDPH) Practitioner Orders for Life-Sustaining Treatment (POLST) Form is always voluntary. This order records a patient’s wishes for medical treatment in their current state of health. The patient or patient representative and a health care provider should reassess and discuss interventions regularly to ensure treatments are meeting patient’s care goals. This form can be changed to reflect new wishes at any time. No form can address all the medical treatment decisions that may need to be made. The Power of Attorney for Health Care Advance Directive (POAHC) is recommended for all capable adults, regardless of their health status. A POAHC allows a person to document, in detail, future health care instructions and name a Legal Representative to speak on their behalf if they are unable to speak for themselves.

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