- A Consumer Guide to POLST for Hawai‘i -

Frequently Asked Questions (FAQ)

What is POLST?

POLST = Physician Orders for Life-Sustaining Treatment, is your care wishes:

• Carried out through your doctor’s orders

• Followed by health care providers, including Emergency Medical Services, such as Paramedics.

  • You use POLST when you have a serious health condition.
  • Social workers, nurses and other healthcare professionals can help you fill out your own POLST form or that of a loved one, but it MUST be signed by your physician in order to be valid.
  • POLST contains medical orders indicating what medical care you want or don’t want if you become unable to make the decisions yourself.
  • Your doctor, who is licensed in the State of Hawai’i (or allowed to practice if from the Military or VA) MUST review and sign the POLST form.
  • POLST also requires your signature or that of your healthcare power of attorney, surrogate decision maker, or guardian.

When would I need a POLST form?

  • The POLST form is intended for a person who has a chronic debilitating illness or is facing a life limiting disease, such as end-stage lung or heart disease or a terminal cancer.
  • The decision to create a POLST should be discussed with each person’s own doctor.

The POLST form asks for information about your preferences for medical treatments:

  • Attempt cardiopulmonary resuscitation (CPR),
  • The intensity of medical care you want,
  • If you want to be hospitalized and under what conditions, and
  • If you want artificial nutrition by tube


How do I get a copy of the POLST form?

The Kōkua Mau website is the central source for POLST information for Hawai‘i.  You or your doctor can download a POLST form and instructions for your doctor.  Some hospitals, nursing homes, home health and hospice providers as well as others in the community may also have the form for you, and can provide some assistance in understanding it and filling it out. Please remember that your POLST form must be signed by your doctor to be valid.

Does the law require that I complete a POLST?

No.  POLST is voluntary and has only been available in Hawai‘i since July 2009. However without a POLST, Emergency Medical Services (EMS) or other healthcare providers may be required to attempt to restart your heart and breathing should they stop, even if you do not wish an attempt to be made to resuscitate you, and would prefer to die a natural death.

Where is the POLST form kept?

If you live at home you should keep the original lime green POLST form in a location where it can easily be seen. The ideal place is on your refrigerator where EMS personnel will look for it first.  Other visible places could be the back of the bedroom door, on a bedside table, or in your medicine cabinet. If you reside in a long-term facility, your POLST form may be kept in your medical chart along with other medical orders. A copy of your POLST form is legal. 

► Does the POLST form need to be signed?

Yes.     Your doctor must sign the form in order for it to be a “Physician’s Order” that is understood and followed by other health care professionals, including EMS personnel.  The form also requires the signature of the person for whom the form is being completed or their healthcare power of attorney or surrogate decision maker.

► If I have a POLST form do I need an Advance Health Care Directive (AHCD) too?

It is highly recommended that you also complete an Advance Health Care Directive, but it is not required. An Advance Directive is the best way to:

  • make your wishes for treatment be known, and
  • appoint an agent to act as your health care power of attorney in the event you may be are unable to speak for yourself.

The POLST form is not the right tool to appoint your agent for the AHCD, since POLST is a physician’s order. You may obtain more information about advance directives from your doctor. For information from Kōkua Mau please follow our Advance Directive link. The combination of POLST and AHCD gives you the best opportunity to have your wishes followed in the event you cannot speak for yourself.

► What if I am no longer able to communicate my wishes and I do not have a POLST?

Through an ACHD, you should appoint a health care power of attorney who can speak on your behalf in case you are no longer able to speak for yourself.  Your doctor can complete the POLST form with your healthcare power of attorney or surrogate decision maker based on their understanding of your wishes.

► In what setting is the POLST form used?

The completed, signed POLST form is a physician order that will remain with you if you are transported between care settings, regardless of whether you are in the hospital, at home or in a long-term care facility. The POLST form is designed to be used to convey your doctor’s orders to healthcare providers including paramedics who arrive after 9-1-1 has been called.

► Why is the POLST Form lime green?

The lime green form is brightly colored so it can easily be found when needed and because it copies clearly on white paper. A plain white copy, completed correctly, and signed by a doctor is equally legal and valid. It will also be honored by health care providers including EMS personnel.

Looking for POLST Information for other States besides Hawai‘i?

Hawai‘i was the seventh State to pass a POLST law. Please visit POLST.org to see what form of POLST is offered in other States.

Questions about the 'comfort care only' bracelet or necklace (DNR bracelet) available in Hawai‘i since 1995? More here