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Washington Physician Orders for Life-Sustaining Treatment (POST)

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The Washington physician orders for life-sustaining treatment (POST) provides medical professionals with instructions not to apply life-saving treatments to an individual experiencing cardiac or respiratory arrest. A patient with a POST order will not receive cardiopulmonary resuscitation (CPR), though standard therapeutic procedures will still be administered. It will be necessary for the order to be signed by both the attending health care professional and the patient (or their authorized representative) before the document will be valid. Once signed, the document should be kept close to the patient and made easily accessible to the emergency medical staff.

Laws – § 43.70.480 and § 70.245

Required to Sign (POLST) – Patient (or a representative) and MD/ARNP/PA-C.

How to Write

Step 1 – Download the Washington POLST form in Adobe PDF.

Step 2 – Below the title of the form, enter the patient’s full name, date of birth, last four (4) digits of SSN, medical conditions/medical goals, and their agency info/sticker.

Step 3 – In section A, select either “Attempt Resuscitation/CPR” or “Do Not Attempt Resuscitation/DNAR (Allow Natural Death)” to specify whether or not the patient should be resuscitated.

Step 4 – Select one (1) of the three (3) options available in section B to indicate the medical interventions which shall be administered when the patient has a pulse or is still breathing.

Choose “FULL TREATMENT” if the patient should be treated with all medical interventions which will effectively prolong their life.

Choose “SELECTIVE TREATMENT” if the patient’s medical conditions should be treated while avoiding undesirable and burdensome treatments such as intubation.

Choose “COMFORT-FOCUSED TREATMENT” if the primary goal is to maintain the patient’s comfort. This option offers the patient general care to alleviate pain and suffering.

Step 5 – Additional orders may be entered in the remaining space in section B.

Step 6 – In section C, below the “Discussed with” heading, select one (1) of the boxes to indicate who had spoken with the health care professional regarding the issuance of the POLST form.

Step 7 – Also in section C, the health care professional must enter their printed name, phone number, signature, and the date.

Step 8 – Continue filling out section C by having the patient (or representative) enter their name, phone number, signature, and the date the form was signed.

Step 9 – Complete section C by specifying whether or not the patient has a health care directive (living will) or a durable power of attorney for health care. Select one (1) of the boxes to indicate this information.

Step 10 – Below the “Patient and Additional Contact Information” heading on page (2), the following contact information must be supplied (if applicable):

  • Patient’s name (last, first, middle)
  • Patient’s date of birth
  • Patient’s phone number
  • Name of guardian, surrogate, or other contact person
  • Guardian, surrogate, or other contact person’s relationship to patient
  • Guardian, surrogate, or other contact person’s phone number

Step 11 – Select one (1) of the options in section D to specify whether antibiotics should be used to prolong the patient’s life, or if antibiotics should not be used unless needed for symptom management.

Step 12 – Also in section D, select one (1) of the following options to indicate the preferred method of medically assisted nutrition:

  • Trial period of medically assisted nutrition by tube (describe goal)
  • Long-Term medically assisted nutrition by tube
  • No medically assisted nutrition by tube

Step 13 – Continue with section D by entering any additional orders in the space provided.

Step 14 – Finish section D by having the health care provider and the patient (or representative) supply their signatures and the date.

Step 15 – The POLST form should be reviewed by a health care professional if the patient is transferred to another medical facility, has a change in health status, or if their treatment preferences change. In these cases, the health care professional must fill out the area below the “Review of this POLST Form” heading. The following information must be entered in the empty fields:

  • Review date
  • Reviewer name
  • Location of review
  • Review outcome



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