Oregon POLST Registry: How It Works and Why Your Advance Directive Isn't Enough

Oregon pioneered the Portable Orders for Life-Sustaining Treatment (POLST) program in 1991 — the first of its kind in the nation. The state also operates an electronic POLST Registry that lets emergency providers access your medical orders statewide, even if you're found unconscious without paperwork.

But most Oregonians confuse POLST with an advance directive. They serve fundamentally different purposes, and understanding the difference can determine whether your emergency wishes are actually followed.

POLST vs. Advance Directive: The Core Difference

An Advance Directive is a planning document for any adult. It names your Health Care Representative and records your treatment preferences for future incapacity. Hospitals use it when you can no longer communicate.

A POLST is a set of active medical orders signed by a licensed healthcare professional (MD, DO, NP, PA, or ND). It tells EMTs and hospital staff exactly what to do right now — attempt CPR or not, provide comfort measures only, or pursue full treatment.

The critical distinction: an advance directive expresses wishes. A POLST issues orders that first responders must follow immediately.

Who Actually Needs a POLST

A POLST is specifically designed for people who are seriously ill or frail — individuals whose healthcare provider would not be surprised if they died within the next year. That includes people with:

• Advanced cancer or organ failure
• Late-stage dementia or ALS
• Severe frailty or repeated hospitalizations
• Any condition where a medical crisis is foreseeable

If you're a healthy adult completing your end-of-life planning, you need an Advance Directive, not a POLST. Getting a POLST "just in case" isn't recommended because it can trigger unwanted limitations on care before you're actually in a life-threatening situation.

What the Oregon POLST Form Covers

The current version is the 2023 Oregon POLST (Version 14). It has four key sections:

Section A (CPR): For patients who are unresponsive, pulseless, and not breathing — either "Attempt Resuscitation/CPR" or "Do Not Attempt Resuscitation/DNR."

Section B (Medical Interventions): For patients who have a pulse and are breathing. Three levels:

• Comfort Measures Only — positioning, oxygen, pain medication. No hospital transfer unless needed for comfort.
• Selective Treatment — IV fluids, antibiotics. No intubation or intensive care.
• Full Treatment — intubation, mechanical ventilation, ICU admission.

Section C (Documentation): Lists everyone who participated in the POLST discussion — protecting the patient's right to a support person.

Section D (Registry opt-out): POLST forms are automatically submitted to the Oregon POLST Registry unless you check the opt-out box.

How the POLST Registry Works

Once signed, your POLST is automatically entered into the electronic Oregon POLST Registry. This means:

• Emergency medical technicians can pull up your orders statewide, even if you're away from home
• You don't need to carry the paper form for your orders to be accessible
• Hospital emergency departments can verify your POLST before starting treatment

The registry is searchable by any authorized healthcare provider in Oregon. This solves the fundamental problem with paper-only medical orders: if the form is in a drawer at home and you collapse at a grocery store, no one sees it.

How to Get a POLST Form in Oregon

You can't fill out a POLST on your own. The process requires a conversation with your healthcare provider:

1. Initiate the conversation with your doctor, nurse practitioner, or physician assistant about your current medical condition and treatment preferences
2. Your provider completes the form based on your discussion and clinical situation
3. Your provider signs the POLST — making it an active medical order
4. The form is submitted to the POLST Registry (automatic unless you opt out)

You can also discuss POLST during any hospital admission, hospice enrollment, or skilled nursing facility placement.

Revoking or Changing a POLST

A capable patient or authorized Health Care Representative can void a POLST at any time:

1. Draw a line through Sections A through E on the paper form
2. Write "VOID" in large letters across the form
3. Send a copy of the voided form to the Oregon POLST Registry to update the electronic record

If your condition changes and you want different orders, your provider can complete a new POLST that replaces the old one.

Why You Need Both Documents

An advance directive without a POLST means your wishes are documented but not immediately actionable in an emergency. A POLST without an advance directive means EMTs know what to do in a crisis, but if you're hospitalized and conscious, there's no designated representative to make decisions if you lose capacity.

The complete approach: an Advance Directive for long-term planning, and a POLST (when medically appropriate) for immediate emergency orders.

Get Your Planning Started

The Oregon Advance Directive & Living Will Kit walks you through Form OHA 3905 step by step and includes a POLST coordination reference guide — so you understand when to ask your doctor about a POLST and how it works alongside your advance directive.

See more Oregon guides →