The Provider Orders for Life Sustaining Treatment (POLST) form is a portable medical order that can give patients with advanced serious illness the option to exercise increased control over the treatment they do and do not want to receive at the end of life.


The POLST helps to ensure the patient’s wishes are conveyed to emergency services and other medical providers. The POLST form is used and recognized by hospital systems, long-term care facilities, medical professionals, and emergency medical services throughout Minnesota.  

The POLST form is one part of advance care planning and does not replace a healthcare directive. The POLST form should reflect a patient’s known wishes and should change if the patient’s wishes change. Unlike a healthcare directive, a POLST form must be signed by a licensed provider to be valid.

The MMA first developed a standardized POLST form in 2010 and it has since been adopted across Minnesota. The POLST Minnesota form was revised in 2017 and is now available for use. Previous versions of the Minnesota POLST form remain valid.  
For more information, please contact the MMA (612) 378-1875.

How To Guide

Most POLST discussions take place between nurses or social workers and patients/families. The POLST must be signed by a provider (MD, DO, PA, or APRN) to become an actual medical order. 

Regardless of who has the POLST discussion it is essential that the information presented to the patient/family be accurate to allow for informed decision making. We have developed a program that we believe best assures that the patient/family are provided standardized information on their POLST choices.

Step 1
The patient/family should first view a 12-minute YouTube video that explains the POLST and the choices. The video is an overview of the Indiana POST form, which is very similar to the Minnesota POLST form.  

POST Basics - An Overview of Important Treatment Decisions

Step 2
Review the scripted conversation between a healthcare professional (usually a nurse or social worker) and the patient/family that reiterates the material in the video. There are three versions of this script: 1) one intended for clinic and homecare patients 2) one intended for resident/family of Assisted Living or Skilled Nursing Facility or 3) one intended for hospice patients.   

Step 3
Deliver the completed POLST to the provider for signature. It is vital that the signing providers familiarize themselves with the content of the video so that he/she is confident that the patient/family have made informed choices.