Pre-2023 Hawaii POLST Form

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 (download link)

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

How do you determine which version of POLST you have in front of you?

Just have a look (hint: no image of the islands)

Here is an image of the content and the layout of of the pre-2023 POLST form for Hawaiʻi. Please only print and use the updated POLST form.