POLST Download
Before you download, please
note the following:
This downloadable form is meant to serve as a master
copy to be used to print bulk quantities (or single
copies) of the form. It should be printed on 8-1/2"
x 11" green card stock,
front and back. For the card stock, you can use Astrobrights
terra green (smooth finish), 65 lbs. (#22781), or
an equivalent.
NOTE:
If you are a patient and want a POLST form for your
own use or for a loved one, ask your physician or
your physician's office for the form. If your physician
does not have the forms in stock, they can order them
in bulk by calling toll-free, 1 (800) 237-3329.
Note: the POLST form was revised December 2006.
The previous version will still be honored.
To download the
POLST form, click here .
(The POLST download is in [PDF]
format and requires the use of Acrobat Reader. To
download a FREE copy of Reader, please click on the
Adobe icon)
If you have problems with the download, or have questions
regarding the printing/distribution of the form, please
contact Graham Short at 1 (800) 552-0612, or email gfs@wsma.org. Back to
POLST main page
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