Oregon has been the founding POLST program since the early 1990s, and the approach has since spread to other states. For people with Medicare thinking about advance care planning, POLST is one of Oregon's most distinctive tools.
A POLST is not the same as an advance directive. An advance directive states your general wishes and names someone to speak for you. A POLST is a medical order, signed by a clinician, about specific treatments now.
What a POLST does
A POLST turns your wishes about end-of-life treatment into medical orders that travel with you from home to hospital to care facility. On the 2023 Oregon POLST form:
- Section A, cardiopulmonary resuscitation (CPR): whether to attempt CPR if you have no pulse and aren't breathing.
- Section B, medical interventions: the level of treatment when you do have a pulse or are breathing: Comfort Measures Only, Selective Treatment, or Full Treatment. An order to attempt CPR requires Full Treatment in Section B.
A section left blank means full treatment for that section.
Who should consider a POLST
The Oregon POLST Program says a POLST is for people with a serious progressive illness, such as advanced heart disease, advanced lung disease or cancer that has spread, and for older, frail people who may not want every available treatment. Healthy adults should complete an advance directive instead.
No health care professional, care facility or health system can require you to have a POLST.
The Oregon POLST Registry
Oregon law (the POLST Registry Act, ORS 127.663 to 127.684, and rules in OAR chapter 333, division 270) set up a statewide registry for the Oregon Health Authority. OHSU's Department of Emergency Medicine has operated it since 2009.
- The clinician who signs your POLST, whether a physician, nurse practitioner, physician assistant or naturopathic physician, must submit it to the registry unless you check the box to opt out.
- Emergency responders and emergency departments can check the registry if the paper form isn't with you.
- You can call the registry at 1-877-367-7657 to ask whether a form is on file. Revised and voided forms are also sent to the registry unless you opted out.
POLST and Medicare
A POLST isn't a Medicare benefit on its own; it is a clinical form. But Medicare covers the conversation:
- Advance care planning is a covered Part B service. Your doctor or other provider can bill Medicare for time spent discussing your goals of care and completing or updating a POLST or an advance directive.
- You pay nothing if advance care planning is part of your Welcome to Medicare visit or yearly Wellness visit and your provider accepts assignment. As part of other care, you pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026).
- Hospice teams, covered by Medicare Part A, regularly talk with patients about POLST and goals of care. See end-of-life Medicare in Oregon.
POLST vs. advance directive
| Advance directive | POLST | |
|---|---|---|
| What it is | A legal document you complete | A medical order a clinician signs |
| Who it's for | Any adult | People with serious illness or frailty |
| What it does | Names a health care representative and records wishes for the future | Gives orders about CPR and level of treatment now |
| Oregon form | Form adopted by the 2021 Legislature (SB 199) | 2023 Oregon POLST form |
Many Oregonians with serious illness have both. A healthy 65-year-old usually needs only an advance directive; see how to make an advance directive in Oregon.
Updating or voiding a POLST
Review your POLST with your clinician when:
- you move between care settings (home to hospital, hospital to a care facility);
- your health changes substantially; or
- your treatment preferences change.
You can ask to void your POLST at any time. Tell your clinician, who completes a new form or voids the old one; a voided form is sent to the registry unless you opted out.
How to start a POLST conversation
- Bring it up. Ask your primary care provider or the specialist who treats your serious illness: "Given my health, would a POLST make sense for me?"
- Bring your representative. If you've named a health care representative in an advance directive, invite them.
- Take your time. The conversation can span more than one visit; Medicare covers advance care planning as part of your care.
- Keep it findable. Keep the original at home where emergency responders can see it, and confirm with the registry that it's on file.
For forms and education materials, contact the Oregon POLST Program at oregonpolst.org (503-494-3965).
Related guides
End-of-life Medicare in Oregon
Hospice, palliative care and advance care planning.
What is a POLST form in Oregon?
The short answer.
Death with Dignity Act and Medicare
What the law requires and what Medicare pays.
Sources
- Oregon POLST Program — Portable Orders for Life-Sustaining Treatment
- 2023 Oregon POLST Form (sample, PDF)
- OHSU — Oregon POLST Registry
- ORS 127.666 — POLST registry (oregon.public.law)
- OAR 333-270-0040 — Submission of POLST forms (via Cornell LII)
- OAR 333-270-0050 — Access to the registry (via Cornell LII)
- Medicare.gov — Advance care planning
- Oregon Health Authority — Advance Directive Adoption Committee
Frequently asked questions
Is a POLST legally binding in Oregon?
A POLST is a signed medical order, and emergency medical services and other health care providers follow it. No one can be required to have a POLST, and you can ask to change or void it at any time.
What is the difference between a POLST and an advance directive?
An advance directive is a legal document any adult can complete to name a health care representative and record wishes for the future. A POLST is a medical order signed by a clinician for someone who is seriously ill now, stating which treatments to use or not use. Many people with serious illness have both.
How do I get my POLST into the Oregon POLST Registry?
The clinician who signs your POLST (a physician, nurse practitioner, physician assistant or naturopathic physician) is required to submit it to the registry unless you choose to opt out on the form. You or your family can call the registry at 1-877-367-7657 to ask whether a form is on file.
Does Medicare pay for a POLST?
The form itself has no charge. Medicare Part B covers voluntary advance care planning with your provider, which can include completing a POLST. You pay nothing if it's part of your yearly Wellness visit and your provider accepts assignment; otherwise the Part B deductible and 20% coinsurance apply.
Where should I keep my POLST?
Keep the original where emergency responders can find it at home, and make sure your clinician's office has a copy. Unless you opted out, the Oregon POLST Registry also has it, so emergency departments and EMS can check it if the paper form isn't with you.
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