What must a valid POLST Form contain?

• A. Patient's name and date of issuance only.
• B. Patient's name and orders for cardiac arrest.
• C. Patient's name, orders for cardiac arrest, signature of patient or legal representative, signature of qualified health care practitioner, and date.
• D. Orders for cardiac arrest and date only.

Answer: (C)

A valid POLST form is a patient-centered set of medical orders that travels with the patient and becomes binding when properly completed. It must identify the patient, specify the orders for life-sustaining treatment (including what to do for cardiac arrest), and be authenticated with the patient’s or their legal representative’s signature as well as the signature of a qualified health care practitioner who issued the orders, plus the date to show when it was completed. Missing any of these elements means the form may not be legally enforceable or current, which is why all of them are required together.