2011 POLST Form

1. 2011 POLST Form

2. Background Component of POLST Quality Improvement Process – review comments/ suggestions every 2 years POLST Documentation Committee POLST Task Force EMSA Commission

3. Key Messages The POLST form is voluntary Previous POLST forms are still valid Ensure the Advance Directive and POLST form are consistent Emphasize role of the Legally Recognized Decisionmaker

4. Rollout Strategy Educational Materials: Summary of the changes with rationale Minor modifications to POLST curriculum Newsletter article Translations – Websites CDPH – AFL and MDS Chinese, Spanish, Farsi, Korean, Russian, Tagalog, Vietnamese

5. Guiding Principle Changes must provide substantial and significant improvement or clarification to the form In addition: Maintain one page (two-sided) format Kept all critical information on front of form

6. General Changes Ultra Pink 65# cardstock Made by Mohawk Available at FedEx/Kinko’s Changed health care ‘professional’ to health care ‘provider’ – consistent with language in POLST law

7. 2011 POLST Form Original POLST Form

8. 2011 POLST Form Original POLST Form

10. 2011 POLST Form Original POLST Form

11. 2011 POLST Form

12. Original POLST Form

13. 2011 POLST Form Original POLST Form

17. Things to Remember Previous POLST forms remain valid Best practice – start using new POLST form after 4/1/11 POLST on any color paper is valid Copies/faxes are valid