Multilingual POLST Form for Hawaii

POLST (Provider Orders for Life-Sustaining Treatment) is a medical order that gives patients more control over their end-of-life care.

Produced on a distinctive bright green form and signed by the patient and her/his physician, Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA) POLST specifies the type of medical treatment that a patient wishes to receive towards the end of life.

Provider Orders for Life-Sustaining Treatment, is your care wishes carried out through:Your medical orders, completed by a doctor or an Advanced Practice Registered Nurse (APRN) for your care right now.

As of May 2023, we have an Improved Hawaiʻi POLST Form! 

With input from local key informants, reviewing the national POLST form and best practice in other states, the Hawaiʻi POLST Task Force agreed on some improvements to our Hawaiʻi POLST Form. This change was approved by the DOH in May 2023. We encourage everyone to use the updated version of POLST which is the version used in the translations.

If you have the pre-May 2023 Hawaiʻi POLST version, it remains valid and does not expire. (See text blow)

The translated forms are for educational purposes only, to be used when discussing a patient’s wishes documented on the POLST form. The signed POLST form must be in English so that emergency personnel can read and follow the orders.

Since June 2023 the Hawaii POLST Form is available in 11 languages.

The English POLST Page and

Read or download the Multilingual POLST Information for Consumers, a two-page sheet explaining what POLST is all about in non-medical terms.

The Hawaiʻi POLST form was updated in May 2023. We encourage everyone to use the updated version of POLST. If you have the pre-May 2023 version, it remains valid and does not expire.  For your convenience, in case you are working with a friend or client with a pre-2023 POLST form, a PDF of these is provided on the main page of each language.