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 or Advanced Practice Registered Nurse (APRN), POLST specifies the type of medical treatment that a patient wishes to receive towards the end of life.

POLST Form for Hawaii provided by Kokua Mau

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 2016 the Hawaii POLST Form is available in 10 languages.

  • Please make sure that you visit:

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.