The MMA has been instrumental in developing a standardized Provider Orders for Life-Sustaining Treatment (POLST) form that can be used for patients diagnosed with serious illnesses throughout Minnesota.
In 2009, the Minnesota Medical Association hosted a interdisciplinary task force to develop the standardized
form that is now endorsed by the MMA and the Emergency Medical Services Regulatory Board.
The target audience for this form are patients diagnosed with serious illnesses such as those enrolled in hospice programs, living in nursing homes and using home care agencies.
The MMA recommends that physicians read both the instructions on the back of the form and the MMA's FAQ about the form before using it with patients.
More information about the form can be obtained by calling MMA Policy Counsel,
POLST Work Group Page
Teresa Knoedler at (612) 362-3738.
You will need to use Acrobat to "stamp" your logo into the document.
Click here for step-by-step instructions.
Contents of the kit include:
- One copy of the MMA-endorsed POLST form;
- One copy of the Frequently Asked Questions sheet;
- One copy of the article, The Need for POLST: Minnesota’s Initiative,
Minnesota Medicine, January 2010
If you do not have access to a printer and need to have a hard copy of the items above mailed to you via U.S. mail, please click on the following link:
Request POLST kit