If you've been handed a brightly colored form at the hospital and told it's a "POLST" or a "MOLST," you may have felt a wave of confusion on top of an already overwhelming situation. Unlike a living will or healthcare proxy designation, this form isn't a statement of general wishes — it's an actual medical order, signed by a physician, nurse practitioner, or physician assistant, that tells other clinicians and emergency responders exactly what kind of care to provide right now. Making things more confusing, the form goes by different names depending on where you live: POLST, MOLST, POST, MOST, or COLST.
This guide explains what a POLST or MOLST form is, who typically needs one, how it's different from — and complementary to — a living will or healthcare power of attorney, and how to go about getting one for yourself or a loved one. This is educational information only, not medical or legal advice. Whether a POLST or MOLST is appropriate for you or someone you love is a decision to make together with the physician, nurse practitioner, or palliative care team managing that person's illness.
What Is a POLST Form?
POLST stands for Physician Orders for Life-Sustaining Treatment (in some states, "Provider" replaces "Physician" to reflect that nurse practitioners and physician assistants can also sign it). According to National POLST, the nonprofit that coordinates POLST programs nationwide, "POLST gives seriously ill people more control over their health care treatment, particularly in case of a medical emergency." A POLST form "translates patient wishes into medical orders that instruct medical teams what to do for a seriously ill person when they cannot speak for themselves."
A medical order, not just a preference document
This is the single most important thing to understand about POLST: it is a standing medical order, similar to a prescription. It must be signed by a licensed healthcare provider — typically a physician, nurse practitioner, or physician assistant — after a conversation with the patient (or their legally recognized decision-maker). Because it's a medical order rather than a legal declaration of wishes, EMS personnel, hospital staff, and nursing home caregivers are trained and, in most states, legally required to follow it immediately, without needing to track down a family member or interpret a broader document first.
Portable across every care setting
A POLST form is designed to travel with the patient. Whether someone is at home, in an ambulance, in the emergency department, in a skilled nursing facility, or transferring between any of these settings, the same form is meant to follow them and be honored consistently. As one provider guide from Honolulu's Emergency Services Department puts it, "the POLST form is designed to be a standard form that may be accepted by all providers across the state. As a legal physician's order, it will be honored by EMS." This portability is what distinguishes POLST from many other healthcare documents, which may not transfer smoothly between a hospital, a nursing facility, and a patient's home.
Why the form is often brightly colored
Many states print their POLST forms on distinctive, bright paper — hot pink in California and several other states, lime green in Washington and Hawaii, or bright yellow in Virginia, for example. The idea is purely practical: in an emergency, first responders need to find and recognize the form quickly, whether it's posted on a refrigerator, kept at a patient's bedside, or filed at the front of a medical chart. Importantly, the color is a convenience, not a legal requirement — a photocopy, fax, scanned PDF, or even a form printed on plain white paper is generally still valid, as long as it carries the required signatures.
What Is a MOLST Form (and Other State Variants)?
MOLST stands for Medical Orders for Life-Sustaining Treatment. It describes the identical underlying concept as POLST — a signed, portable medical order — but is the name used in several states, most notably New York, Massachusetts, Connecticut, Rhode Island, Maryland, and Ohio, according to Heart to Heart Hospice.
Other regional names carrying the same meaning
Beyond POLST and MOLST, you may encounter:
- POST — Physician Orders for Scope of Treatment
- MOST — Medical Orders for Scope of Treatment
- COLST — Clinician Orders for Life-Sustaining Treatment
The American Association of Nurse Practitioners confirms that these are all regional variations on the same underlying tool, differing mainly in name, form design, and the specific rules set by each state.
Why the naming varies from state to state
Advance care planning law is largely delegated to individual states, so each state runs its own POLST-type program under what's known as the "National POLST paradigm." According to the National POLST Form Guide, each state creates its own rules about the form's name, its color, what language is required, who is authorized to sign it, and whether a form completed in another state will be honored. National POLST also maintains a National POLST Form intended for use in participating states, alongside each state's own customized version — you can look up your state's specific program and form through the National POLST State Program Directory. Notably, some states have moved toward this standardized approach over time; Massachusetts, for instance, transitioned from its own MOLST form to the National POLST Paradigm form, according to the Massachusetts Medical Society.
Because forms and reciprocity rules differ by state, if a patient moves or is being treated in a state other than where the form was signed, it's worth confirming with the new state's program — or the treating clinician — whether the existing form will be honored or whether a new one should be completed.
POLST/MOLST vs. Living Wills and Advance Directives
One of the most common sources of confusion is assuming a POLST or MOLST replaces documents like a living will or Five Wishes advance directive. In reality, they serve different purposes and work best as a team.
Advance directives are legal documents; POLST/MOLST are medical orders
A living will, healthcare proxy designation, or Five Wishes document is a legal document — completed by the individual, often with a notary or witnesses, and generally without a clinician's signature. It expresses general wishes about future medical care and typically names a healthcare agent to make decisions on the person's behalf, as discussed in our guide to healthcare power of attorney vs. healthcare proxy. Every competent adult 18 or older is encouraged to have one, regardless of current health.
A POLST or MOLST form, by contrast, is a medical order signed by a healthcare provider. According to the National Council on Aging, this signature requirement is what distinguishes POLST/MOLST from advance directives, which do not require a clinician's signature to be valid.
Immediate effect vs. interpretation by a proxy
Because a POLST/MOLST is already framed as specific medical orders — for example, "do not attempt resuscitation" or "comfort-focused treatment only" — EMS and clinical staff can act on it immediately without stopping to interpret broader wishes or locate a decision-maker. An advance directive, by comparison, generally requires someone (often the healthcare agent named in a healthcare proxy document) to interpret the patient's stated values and translate them into real-time decisions, which can take precious time in an emergency.
Better together, not as substitutes
Rather than choosing one over the other, most experts recommend having both, especially once serious illness enters the picture. A provider guide from Honolulu's emergency services department recommends that "a patient with a chronic debilitating disease, a seriously ill patient, or a terminally ill patient have both an Advance Health Care Directive and a signed POLST form." The advance directive lays out broader values and names a decision-maker for situations the POLST doesn't cover; the POLST/MOLST turns the immediate, most urgent preferences into an order clinicians and EMS must follow on the spot.
Who Should Consider a POLST/MOLST Form?
POLST and MOLST forms are not meant for every adult — and that's an important distinction from advance directives.
Designed for serious illness, advanced frailty, or limited life expectancy
National POLST describes the intended population as people "dealing with progressing serious illness and/or frailty due to aging." A commonly cited clinical benchmark — sometimes called the "surprise question" — is whether the patient's physician would not be surprised if the patient died within the next year, a standard referenced in a 2014 American Bar Association analysis of POLST law and practice. Some state programs describe eligibility slightly differently — for example, Pennsylvania's POLST program notes it's intended for patients whose clinician "would not be surprised if they died within 1–2 years," or those with frequent hospitalizations and increasing frailty, according to the Pennsylvania POLST program. Heart to Heart Hospice similarly notes that POLST/MOLST forms are "specifically intended for patients with advanced, progressive illness and/or frailty with limited life expectancy," in contrast to living wills, which apply to any adult regardless of current health, as detailed by Heart to Heart Hospice.
Not necessary for healthy adults
If you're a generally healthy adult without a serious diagnosis, a POLST or MOLST form isn't the right tool — a living will, healthcare proxy, or a document like Five Wishes is more appropriate at this stage of life. POLST/MOLST becomes relevant later, when a serious illness, advanced frailty, or a life-limiting diagnosis makes near-term medical decisions more concrete and pressing.
Common in hospice and palliative care settings
It's very common for a POLST or MOLST conversation to happen alongside a referral to hospice or palliative care, since these teams specialize in helping patients and families translate personal values into specific, actionable medical decisions. If you or a loved one is navigating a serious diagnosis, ask the treating physician or palliative care team whether a POLST/MOLST conversation makes sense at this point — they're best positioned to weigh in on timing and appropriateness.
What a POLST/MOLST Form Covers
While the exact sections vary by state, most POLST/MOLST forms address a similar core set of decisions.
Resuscitation preferences
The first and often most consequential section addresses what should happen if the patient's heart stops or they stop breathing: attempt cardiopulmonary resuscitation (CPR), or allow natural death without CPR — sometimes referred to as a Do Not Resuscitate (DNR) order. It's worth understanding that a DNR order can exist on its own, but a POLST/MOLST form's resuscitation section functions as a DNR order when that option is selected, while also addressing many other treatment decisions in one place.
Level of medical intervention
Beyond resuscitation, most forms let the patient specify a broader scope of treatment for situations where their heart is still beating and they're still breathing. Typical categories include:
- Full treatment — all appropriate medical interventions, including transfer to a hospital and intensive care if needed
- Selective treatment — medical treatment including antibiotics and IV fluids, but generally avoiding intensive care or mechanical ventilation
- Comfort-focused treatment — treatment focused on relieving pain and symptoms, generally avoiding hospital transfer unless comfort needs can't be met elsewhere
Artificial nutrition and hydration
Many state forms include a section on whether the patient wants a feeding tube or other artificial nutrition, and for how long — for example, a defined trial period versus long-term use versus none at all.
Antibiotics and other specific interventions
Some state versions include additional sections addressing antibiotics, dialysis, or other specific interventions, depending on how detailed that state's form is designed to be. Because these sections vary meaningfully by state, it's worth reviewing your specific state's form with the signing clinician rather than assuming it matches what you've seen elsewhere.
How to Get a POLST/MOLST Form
It starts with a conversation, not paperwork
A POLST or MOLST form isn't something you fill out alone or download and sign on your own. It's initiated through a guided conversation with a physician, nurse practitioner, or physician assistant, who discusses the patient's diagnosis, prognosis, and goals of care before translating those wishes into specific medical orders. Completing the form is entirely voluntary — no one is required to have one, and a patient (or their legal decision-maker) can decline at any point, a point emphasized by both the American Association of Nurse Practitioners and multiple state POLST programs.
Signatures required from both parties
To be valid, the form generally must be signed by both the patient (or their authorized surrogate decision-maker, such as someone holding healthcare power of attorney) and the certifying healthcare provider. Without both signatures, the form isn't a valid, actionable medical order.
Where to keep it
Once signed, the original form should stay with the patient. Common recommendations include:
- Posting it in a visible spot at home, such as near the patient's bed or on the refrigerator — both places EMS personnel are trained to check
- Keeping a copy in the patient's medical records at their hospital, nursing facility, or hospice provider
- Carrying a copy when traveling between care settings, such as to appointments or during a hospital transfer
- Registering it in a state e-registry, where available, so it can be electronically retrieved by authorized providers
Photocopies, scans, and faxes of a signed POLST/MOLST are generally treated as valid as the original, which offers helpful flexibility if the original is misplaced.
State-by-state variation matters
Because each state runs its own program, the exact process, required signatures, and form design differ. The National POLST State Program Directory is the most reliable way to confirm your state's specific form, name, and requirements before assuming a form from another state will transfer directly.
Updating or Revoking a POLST/MOLST Form
Forms can change as circumstances change
A POLST/MOLST form isn't permanent. It can be updated at any time a patient's medical condition, prognosis, or personal preferences change — for instance, after a hospitalization, a significant decline, or simply a change of mind. Common triggers for review, as outlined in Pennsylvania's POLST guidance, include being transferred between care settings, a substantial change in health status, or a shift in treatment preferences. Many programs also recommend an annual review even if nothing specific has changed, simply to confirm the form still reflects the patient's current wishes.
Keep family and healthcare agents in the loop
Because a POLST/MOLST is meant to be followed immediately in an emergency, it's important that family members and any healthcare agent named through a power of attorney or healthcare proxy understand what the form says and why. A form that surprises family members in a crisis can create painful conflict at an already difficult moment — talking it through in advance, ideally with the patient's care team, helps avoid confusion later.
What happens if the form is lost or unavailable
If a POLST/MOLST can't be located during an emergency, EMS and hospital staff generally must default to providing full treatment, including CPR, until a valid form or other order can be confirmed. This is exactly why keeping the form somewhere visible and easy to find — and registering it electronically where a state registry exists — matters so much in practice.
Common Misconceptions
"A POLST is the same as a living will"
As covered above, these are different types of documents serving different purposes: one is a legal statement of wishes for any adult, the other is a signed medical order intended for patients with serious illness or advanced frailty. Ideally, a patient with a serious diagnosis has both.
"Signing a POLST means giving up on treatment"
This is one of the most persistent and unfortunate misunderstandings. A POLST/MOLST form is not inherently about limiting care — it's about documenting individualized preferences, whatever they are. A patient can absolutely select "full treatment" on a POLST form if that reflects their wishes. The form exists to make sure whatever the patient wants — more treatment or less — is honored consistently across every care setting, not to steer people toward less intervention.
"One form works in every state"
Because POLST-type programs are run individually by each state, a form completed in one state may not be automatically recognized in another, and naming conventions differ (POLST, MOLST, POST, MOST, COLST). If a patient relocates or splits time between states, it's worth checking with the new state's program, sometimes findable through the National POLST directory, about whether a new form should be completed.
Talking to Family and Providers About POLST/MOLST
Start with values and goals of care, not just procedures
These conversations tend to go better when they start with a person's values — what matters most to them, what a "good day" looks like, what trade-offs they're willing or unwilling to make — rather than jumping straight into a checklist of medical interventions. A skilled physician, nurse practitioner, or palliative care specialist can help guide this kind of conversation so that the resulting form actually reflects the patient's priorities.
Include the healthcare agent in the discussion
If the patient has named a healthcare agent through a power of attorney or proxy designation, it's important that this person is part of the POLST/MOLST conversation, or at least fully briefed afterward. They may need to speak on the patient's behalf later, and disagreements or surprises about a POLST's contents can create painful confusion during an already stressful emergency. Our guide to healthcare power of attorney vs. healthcare proxy explains how these roles relate to medical decision-making generally.
Lean on hospice and palliative care teams
If a loved one is receiving hospice or palliative care, that team is often exceptionally well equipped to facilitate POLST/MOLST conversations, since discussing goals of care and treatment intensity is central to their work. They can also help families understand what physical changes to expect as an illness progresses — information covered in our guide to the signs of active dying — which can inform how a family thinks about comfort-focused care decisions on the form.
Frequently Asked Questions
What's the difference between a POLST and a living will?
A living will is a legal document expressing general wishes about future care, applicable to any adult 18 or older, and doesn't require a clinician's signature. A POLST/MOLST is a signed medical order intended for people with serious illness or advanced frailty, meant to be followed immediately by EMS and clinical staff. Many patients benefit from having both, as discussed in our guide to advance directives like Five Wishes.
Who is eligible to have a POLST or MOLST form?
POLST/MOLST forms are generally intended for people with serious, advanced, or progressive illness, or significant frailty — often described using the benchmark of whether a physician would not be surprised if the patient died within the next year. They're not typically recommended for healthy adults.
Does a POLST form expire?
Most POLST/MOLST forms don't have a fixed expiration date, but they should be reviewed periodically — especially after a hospitalization, a change in health status, a transfer between care settings, or simply as part of an annual check-in — to confirm they still reflect the patient's current wishes.
Can I say I want full treatment on a POLST form?
Yes. A POLST/MOLST form documents whatever the patient's preferences are, which can include full treatment, including CPR, hospitalization, and intensive care. The form isn't designed to steer patients toward less intervention — it's designed to make sure their actual wishes, whatever they are, are followed consistently.
What happens if I don't have a POLST and I'm unable to speak for myself?
Without a POLST/MOLST or other order on file, EMS and hospital staff will generally provide full treatment, including CPR, by default. If you have an advance directive or a healthcare agent named through a healthcare proxy, that person may be consulted to help guide decisions, but this process takes more time than an immediately actionable POLST order.
Is a POLST form legally binding for EMS and hospital staff?
Yes, in the sense that it functions as a physician's order, which EMS and clinical staff are trained to follow. Many states also provide legal protections for providers who follow a valid POLST/MOLST in good faith. That said, specific legal requirements vary by state, so it's worth confirming the details of your state's program.
Can I get a POLST form if I live in a state without a formal POLST program?
Nearly all states now have some form of a POLST-type program, though the name and specifics vary — check the National POLST State Program Directory for your state's current program. If your state doesn't have a formal program, ask your physician or palliative care team what equivalent tools are available locally, since practices continue to evolve.
Sources:
National POLST — https://polst.org/
National POLST: State Program Directory — https://polst.org/state-programs/
National POLST Form Guide (PDF) — https://polst.org/wp-content/uploads/2022/03/2021.03-National-POLST-Form-Guide.pdf
American Association of Nurse Practitioners: Issues at a Glance — POLST — https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-at-a-glance-provider-orders-for-life-sustaining-treatment-polst
Heart to Heart Hospice: What is MOLST/POLST? — https://hearttohearthospice.com/blog/understanding-medical-orders-for-life-sustaining-treatment-molst-polst/
NCOA: What Is a POLST Directive and Who Needs One? — https://www.ncoa.org/article/advance-care-planning-and-polsts-a-guide-for-older-adults-and-caregivers/
Massachusetts Medical Society: Massachusetts' Transition from the MOLST to the National POLST Paradigm — https://www.massmed.org/Publications/Vital-Signs---MMS-Publication/Massachusetts--Transition-from-the-MOLST-to-the-National-POLST-Paradigm/
Pennsylvania POLST Program FAQ — https://www.papolst.org/pa-polst-forms/the-pennsylvania-orders-for-life-sustaining-treatment-polst-form/114-frequently-asked-questions-updated/file
American Bar Association: Physician Orders for Life-Sustaining Treatment (PDF) — https://www.americanbar.org/content/dam/aba/publications/real_property_trust_and_estate_law_journal/v49/01/2014_aba_rpte_journal_v49_no1_spring_article_wolf_maag_gallant_physician_orders_for_live_sustaining_treatment.pdf