The Oregon POLST Registry

1. The Oregon POLST Registry Information for patients and families

2. What is the Oregon POLST Registry • It is a secure electronic record of your POLST orders • The Registry allows emergency medical professionals access to your POLST orders if the original POLST form cannot be found • The Registry is a back-up system and does not replace your original POLST form

3. How does the Registry work? • If, in an emergency, your POLST form cannot be immediately found, emergency medical professionals can call the Registry to obtain your orders

4. How will the Registry get my form? • The health care professional who signed your form is required to submit your form to the Registry (unless you opt-out) • You can also fax or mail a copy of your form to the Registry: • Registry fax: 503-418-2161 • Oregon POLST Registry 3181 SW Sam Jackson Park Rd CDW-EM Portland, OR 97239

5. What if I don’t want my information in the Registry? • If you don’t want your information in the Registry simply check the ‘opt-out’ box on your form • If your form was entered into the Registry and you would like it removed, contact us! • Phone: 503-418-4083 • Toll free: 877-367-7657 • E-mail: polstreg@ohsu.edu • Submit a web request: www.orpolstregistry.org

6. How will I know my form is in the Registry? • A confirmation letter will be mailed to you if mailing address information was included with your POLST form. • Your confirmation packet will contain a Oregon POLST Registry magnet and set of stickers with your unique Registry ID printed on them • The Registry ID is unique and helps identify your form in the Registry, please refer to this ID any time you call the Registry

7. Confirmation letter • To the right is an example of a confirmation letter • The letter includes: • Your Registry ID • A synopsis of your section A and section B orders • Information on how to contact the Registry

8. Registry Magnets and Stickers • The magnet and stickers are used to alert health care professionals that you have a POLST form on file with the Registry • POLST Registry magnets and stickers do not replace the original POLST form

9. Where do I put my magnet and stickers? • The Registry magnet (example right) should be placed on your refrigerator • It is recommended that you place your stickers: • On your original POLST form • On something you carry with you (ex. your wallet) • The third can be given to your primary care provider

10. Can I get additional magnets and stickers? • Yes! The Registry office is happy to provide you with additional magnets, stickers, and even copies of your POLST form • To request additional materials: • Phone: 503-418-4083 • Toll free: 877-367-7657 • E-mail: polstreg@ohsu.edu • Submit a web request: www.orpolstregistry.org

11. Contact the Registry: • When your POLST orders change • When your personal information changes (address, name, etc.) • When you have questions about the Registry 877-367-7657 We are here to help!

12. How to contact the Registry • Phone: 503-418-4083 • Toll free: 877-367-7657 • Fax: 503-418-2161 • E-mail: polstreg@ohsu.edu • Website: www.orpolstregistry.org