Provider Order Life Sustaining Treatment 2014-2025 Form

What is the Utah State POLST Form

The Utah State Provider Order for Life-Sustaining Treatment (POLST) form is a medical order that outlines a patient's preferences regarding life-sustaining treatments. It is designed for individuals with serious illnesses or those who are nearing the end of life. The POLST form serves as a guide for healthcare providers, ensuring that the patient's wishes are respected in emergency situations. This form is recognized across various healthcare settings in Utah and is crucial for effective communication between patients, families, and medical professionals.

How to Use the Utah State POLST Form

Using the Utah State POLST form involves several key steps. First, patients should discuss their treatment preferences with their healthcare provider. This conversation should cover various scenarios, including resuscitation efforts and the use of life-sustaining treatments. Once the preferences are established, the healthcare provider will complete the POLST form, which must be signed by both the patient (or their legal representative) and the provider. It is essential to keep the completed form in an accessible location, such as with other important medical documents or in a digital format, to ensure it is available during medical emergencies.

Steps to Complete the Utah State POLST Form

Completing the Utah State POLST form involves a systematic approach to ensure that all necessary information is accurately recorded. The steps include:

• Consultation: Schedule a meeting with a healthcare provider to discuss treatment options and preferences.
• Discussion: Clearly communicate your wishes regarding life-sustaining treatments, including resuscitation and artificial nutrition.
• Completion: Fill out the POLST form with the healthcare provider, ensuring all sections are addressed.
• Signatures: Obtain signatures from both the patient (or their representative) and the healthcare provider.
• Distribution: Provide copies of the completed form to relevant parties, including family members and healthcare facilities.

Legal Use of the Utah State POLST Form

The Utah State POLST form is legally recognized and serves as a binding medical order when completed and signed appropriately. It is important to note that the form must be filled out in compliance with state regulations to ensure its validity. Healthcare providers are legally obligated to follow the directives outlined in the POLST form, making it a critical tool for honoring patient wishes in medical emergencies. Familiarity with the legal aspects of the POLST form can help patients and families navigate end-of-life care more effectively.

Key Elements of the Utah State POLST Form

The Utah State POLST form contains several key elements that are essential for conveying patient preferences:

• Patient Information: Includes the patient's name, date of birth, and contact information.
• Medical Orders: Details the patient's wishes regarding resuscitation, medical interventions, and life-sustaining treatments.
• Signatures: Requires signatures from both the patient (or their representative) and the healthcare provider to validate the document.
• Review Date: Indicates when the form should be reviewed to ensure that it remains aligned with the patient's current wishes.

Examples of Using the Utah State POLST Form

Examples of using the Utah State POLST form can illustrate its practical application in healthcare settings. For instance, a patient with a terminal illness may use the POLST form to specify that they do not wish to receive CPR or mechanical ventilation. In another case, a patient may choose to receive comfort measures only, such as pain management, without aggressive interventions. These examples highlight how the POLST form can guide healthcare providers in delivering care that aligns with the patient's values and preferences, ultimately enhancing the quality of life during critical moments.