Rescue. Resource. Response.
For emergencies dial 9-1-1

Medical Directives

San Juan Island EMS and Medevac honors the decision that you make regarding your healthcare choice, especially those pertaining to end-of-life care and directives. Use of the POLST form allows for clear communication and direction to responding EMS and Medevac crews as to your expressed wishes that we can then follow when you are not able to speak for yourself.


What is the POLST form?
The Physician Orders for Life-Sustaining Treatment (POLST) form represents a way of summarizing wishes of an individual regarding life-sustaining treatment. The form is intended for any individual with an advanced life-limiting illness.

The form accomplishes two major purposes:

  • It is portable from one care setting to another.
  • It translates wishes of an individual into actual physician orders.

The attending physician, nurse practitioner or PA-C should complete the document with the patient. The attending physician, ARNP or PA-C must sign the form and assume full responsibility for its accuracy.

The POLST form facilitates the process of translating end-of-life discussions with patients into actual treatment decisions, and provides security for the individual and physician that the expressed wishes will be carried out. There is no other form that streamlines the process in this way.

How is the form used?
In a health care facility, the form should be the first document in the clinical record. It should be recognized as a set of physician orders, to be implemented as any physicians orders would. In a non-institutionalized setting (such as a home), the bright green form should be located in a prominent location. It will be recognized by emergency personnel as orders to be followed.

How is the form transferred from one setting to another?
The completed POLST form is a physician order form that will remain with you if you are transported between care settings, regardless of whether you are in the hospital, at home or in a long-term care facility. The institution may wish to keep a duplicated copy in the permanent medical record upon discharge.

If I have a POLST form, do I need an advance directive, too?
We encourage everyone to have an advance directive, like a durable power of attorney for health care and/or health care directive (also known as a living will). While advance directives are often very helpful in determining end-of-life decisions, they are not required or necessary for having a POLST form.

You may obtain more information about advance directives from your physician, your health insurance provider, or here.

POLST information brochure for patients – in English and Spanish
This tri-fold brochure is designed for your waiting room and/or to be distributed directly to patients, and contain an overview of and frequently asked questions about the POLST form.

Ordering instructions for the patient brochure. At this time the Spanish language brochure is only available as a download for printing.

  • Click here to download a PDF of the English patient brochure.
  • Click here to download a PDF of the Spanish patient brochure.

“POLST Choices for End of Life”
This educational film demonstrates information and techniques for discussing choices with patients and families. It covers, section-by-section, how to complete the POLST form. Whether the person preparing the form is a physician, NP, PA-C, or a nursing home staff member preparing the form for the MD or NP to review and sign, the DVD is designed to help the preparer to skillfully engage patients and families about their treatment options.

Please select the portion of the “POLST: Choices for End of Life” video you’d like to view below.