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New Jersey Department of Health Unveils Its New POLST Form

February 22, 2013 | No Comments
Posted by Beth Christian

The New Jersey Department of Health and Senior Services unveiled a new health care treatment planning tool which is intended to better facilitate implementation of a patient’s treatment goals and wishes. Known as the POLST form (shorthand for Physician/Practitioner Orders for Life Sustaining Treatment), it is designed to be completed concurrently by the patient and their treating physician/advanced practice nurse.  The POLST form is designed to serve as a medical order which will follow the patient across the continuum of care. It outlines the patient’s goals of care. It also outlines the patient’s choices regarding potential medical interventions, and can be used to specify whether or not the patient desires to receive artificially administered fluids and nutrition, as well as CPR/intubation/artificial ventilation.

A patient who executes a POLST form may modify or revoke the POLST form at any time. The patient may also designate a surrogate decision maker, who can modify or revoke the patient’s previously executed POLST orders in consultation with the patient’s treating practitioner if the patient loses their decision-making capacity. The form allows individual to specify whether or not they wish to make an anatomical gift. Properly executed POLST forms are valid medical orders which can be transferred with the patient and are valid in all treatment settings in New Jersey.

The New Jersey POLST form care be found here:

The New Jersey Hospital Association has published a resource for patients and family members concerning POLST that can be found here:


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