July 20, 2012_AFH "Dear Provider" Letters

July 20, 2012

ADSA: AFH #2012-013

Dear Adult Family Home Provider:

We recently received several questions from staff and providers about the "physician orders for life sustaining treatment" (POLST) form.  Some are asking if the form can be used as an "advance directive", and who can implement the POLST.  The purpose of this letter is to remind you of the requirements and provide guidance on this issue.

Here is some key information on POLST:

  • A POLST form is a way of summarizing wishes of an individual regarding life-sustaining treatment.  It is not an advance directive; it is a physician's order that was designed for use by Emergency Medical personnel only.
  • The provider can use the POLST form in the short term to provide guidance regarding a resident's end of life choices until additional information regarding the resident's end-of-life wishes is obtained.
  • Staff that are not licensed medical or nursing professionals, may not have the scope of practice to evaluate the situation or implement the individual's advance directive.
  • Since the POLST form was developed for use by Emergency Medical personnel only; there may be issues related to legal immunity if others follow the POLST form directions.  You may want to consult your attorney for legal advice.

We have enclosed fact sheets regarding POLST, advanced directives and informed consent.  These fact sheets are also available on the Department's website under heading Health Care Decision Making at   https://www.dshs.wa.gov/altsa

The Department of Health provides additional information at the following website:https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/PhysiciansOrdersforLifeSustainingTreatment

The Washington State Medical Association answers Frequently Asked Questions (FAQs) at https://wsma.org/POLST.

Please call your RCS Field Manager if you have any questions about the use of the POLST form.


Joyce Pashley Stockwell, Director
Residential Care Services


  • POLST Fact Sheet
  • Advance Directives Fact Sheet