Nevada POLST Program FAQs
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- May a PA or NP sign a POLST form?
Legally, at this point, only a physician may legally sign a POLST form in Section C. Nevada POLST recognizes the importance of NPs and PAs, especially in our rural communities, to be able to validate a POLST so we will be seeking legislative changes to provide for this important service.
- May a POLST be completed for someone without capacity?
A patient must be able to understand the choices they make in order to complete a POLST form, but the patient’s Durable Power of Attorney for Health Care (DPOA-HC) as established in their AD, or a patient’s legal guardian may complete a POLST for a patient lacking capacity. Unless designated as the DPOA-HC, a family member may not complete a POLST for another family member. The exception to this is a parent of a minor, who is able to complete a POLST for their child.
- If a patient wants Comfort Measures Only, but also hydration, how should the form be completed?
If a patient wants anything other than comfort measures, then Comfort Measures Only (B.1.) should NOT be checked. Any treatments they want should be checked in Sections B.2. (use the line “Other Instructions” if the patient’s request is not listed). As noted at line B.2. comfort measures are included with Section B.2.: “Limited Medical Interventions: Comfort measures always provided.”
- May a patient who previously had capacity, subsequently loses capacity with a significant change of health status have a new POLST completed?
According to Nevada law “A physician may medically evaluate the patient and, based upon the evaluation, may recommend new orders consistent with the most current information available about the patient’s health status and goals of care. Before making a modification to a valid POLST form, the physician shall consult the patient or, if the patient is incompetent, shall make a reasonable attempt to consult the representative [italics added] of the patient and the patient’s attending physician”. (NRS 449.695.2.)
- Is a copy of a Nevada POLST form valid?
As long as a physician has signed and dated Section C and a patient or their legal representative has signed the first line of Section F, then a copy, fax or electronic version of a POLST is valid as is stated at the top of Side 1 of the Nevada POLST form.
- Is a doctor’s signature enough?
To be valid, the Nevada POLST form must be signed and dated by both the patient’s physician and the patient, their Durable Power of Attorney for Health Care (aka DPOA, Agent, Surrogate). Remember, a patient may eventually have multiple POLST forms, or a POLST that doesn’t agree with their Advance Directive. It will be imperative to know which document is the most recent, as it’s directives will prevail. At this time, a physician is the only person who can sign in Section C, not a NP or PA.
- Does the form expire?
The Nevada POLST form does not expire, but should be reviewed with the patient or their representative (DPOA, parent of a child, guardian) if there is a change of health status or they are transferred.
- Can a provider refuse to comply with a POLST?
If a provider feels they cannot comply with the medical orders of the POLST, they must transfer the patient to the care of a provider who is willing to comply.