NJ POLST Form & Video Series

Photo of senior woman, at her home, writing notes about POLSTThe Practitioners Orders for Life Sustaining Treatment, or POLST form, ensures patients get the care they need and no less and the care they want and no more. The POLST form is a medical order, like a prescription, that is completed and used by medical professionals to inform them about what treatments you would or would not want during a medical emergency. It must be signed by a doctor, physician assistant or advance practice nurse and a patient or decision maker. The POLST form is for seriously ill patients or older adults approaching the end of life. The NJ POLST form gives specific care instructions related to your personal goals of care, artificial nutrition, resuscitation and re-hospitalization.

NJ POLST Video Series

Introduction to the New Jersey POLST Form

Duration: 2:50 min.
Summary: This video provides an overview of the POLST form, what it is, who should have one, where it should be placed, and other important details.

Completing the New Jersey POLST Form

Duration: 6:20 min.
Summary: This video explains how to complete a NJ POLST form with a healthcare provider. It reviews each section of the form (Goals of Care, Medical Interventions, Artificially Administered Fluids and Nutrition, CPR/Airway Management, Signatures and Health Care Representative), where the form may be completed and where copies should reside.

A POLST Story — starring Michael Douglas and Danny DeVito

Duration: 2:41 min.
Summary: GOCCNJ teamed up with Hollywood legends, Michael Douglas and Danny DeVito, who donated their time during the covid pandemic to bring awareness to advance care planning through a Public Video Announcement “A POLST Story”.

icon representing Spanish language NJ POLST Video Series with Spanish Subtitles

Introducción al formulario POLST de Nueva Jersey

Completando el formulario POLST de Nueva Jersey

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4Step iCarePlan
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