PA – Orders for Life-Sustaining Treatment (POLST)

Pennsylvania Department of Health Logofrom the PA Department of Health
This form was developed by the Pa Department of Health’s Patient Life Sustaining Wishes Committee and was designed to be consistent with Pennsylvania law. This form was developed by the Pa Department of Health’s Patient Life Sustaining Wishes Committee and was designed to be consistent with Pennsylvania law. There are significant advantages to using a form that contains standardized language and is produced in a distinctive and easily recognizable format.
Download POLST FormIn order to maintain continuity throughout Pennsylvania, please follow these printing instructions:
*** Print POLST Form on 110# Pulsar Pink Card Stock ***

Click on the links below to download

* POLST FORM

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Allegheny County Medical Society
713 Ridge Avenue
Pittsburgh, PA  15212
412-321-5030  FAX 412-321-5323