** Due to the sensitive nature of the information please do not send completed POLST forms to the Wyoming Department of Health Aging Division. We do not have a central registry for Wyoming. These forms are meant for the patient and the medical providers to fill out, and then are posted in your home, facility and to local medical crews or ambulance staff. **
What is WyoPOLST?
The Portable Medical Orders (POLST) form gives seriously ill patients more control over their end-of-life care, including medical treatment such as a ventilator or feeding tube and cardiopulmonary resuscitation (CPR). Honoring the wishes of those with serious illness and frailty, whether they are young or old.
POLST has different names in different states. At the national level, it is simply called POLST: Portable Medical Orders, or POLST for short. Portable means that the order is valid outside the clinic or doctor’s office, similar to a drug prescription.
POLST is a process and a form
POLST is many things, including:
Part of advance care planning, which helps you live the best life possible.
A good talk with your provider about your medical condition, treatment options, and what you want.
A medical order form that travels with you (called a POLST form).
POLST communicates your wishes as medical orders
A POLST form tells all health care providers during a medical emergency what you want:
“Take me to the hospital” or “I want to stay here”
“Yes, attempt CPR” or “No, don’t attempt CPR”
“These are the medical treatments I want”
“This is the care plan I want followed”
POLST is for the seriously ill or frail, young or old.
POLST gives seriously ill or frail people more specific direction over their health care treatments compared to advance directives and more options than Do Not Resuscitate (DNR) orders.
A POLST order helps ensure that medical care provided in the emergency department and out-of-hospital settings is consistent with the patient’s desires. For example, a Wyoming POLST order marked with “Do Not Resuscitate” tells emergency medical technicians, first responders and other emergency healthcare staff members not to attempt cardiopulmonary resuscitation on the person for whom the order is issued if that person suffers cardiac or respiratory arrest.
WyoPOLST is not the same as a DNR only order. DNR’s may not be followed outside of the facility, whereas the WyoPOLST which contains a DNR section is followed statewide and by many other states – Please visit the National POLST website and watch the video to find out more or watch it directly on their YouTube site: How POLST does more than a DNR
WyoPOLST is an addition to an advanced directive or living will, with more information than an advanced directive and with more medical orders going to more providers. Legal Aid of Wyoming can assist with many types of Living Wills if you qualify, so please visit www.lawyoming.org for more information. Also, please visit the National POLST website and watch the video to find out more about Advanced Directives or watch it directly on their YouTube site: POLST is more specialized than Advance Directives
Please visit the National POLST website for more information, resources, and contacts across the United States for patients who cross state lines at any point. polst.org/ (Wyoming recognizes their help with the language and criteria of the What is WyoPOLST section with content from their website. Thank you).
POLST bracelets can be an-easy-to-see POLST notice for healthcare providers. StickyJ Medical ID is the Wyoming Department of Health’s authorized source for POLST bracelets in Wyoming.
The Wyoming surgical stainless steel POLST bracelet is available for $27.90 by mail order from StickyJ Medical ID. An order form can be downloaded here.
Bracelets can also be ordered online at https://www.stickyj.com/category/dnr-jewelry-bracelets, the StickyJ Medical ID website. Please note a completed POLST form is needed for bracelet orders. Please send your order and payment directly to StickyJ Medical ID.
**Due to the sensitive nature of the information please do not send order forms or payment for the POLST bracelet to the Wyoming Department of Health Aging Division. We do not process any order forms or payments. Please send payment to StickyJ Medical ID directly.**
Spanish Education Form
This Spanish WyoPOLST form is intended for educational purposes only, to aid Spanish readers to have the full understanding of what they are agreeing to with their medical provider. There is no need to print the Spanish education WyoPOLST form on gold paper, ordinary plain paper will suffice. It will continue to be the case that the only officially recognized WyoPOLST form will be in English and printed on gold paper, as per legislation. Medical providers will need to print off the education form as an accompaniment to the English WyoPOLST, and review it with your patients alongside the English version.
Statute and Rules
- WyoPOLST is a voluntary process and a form
- Must be completed by a medical provider and the patient together
- Must be printed on gold paper (medical providers will handle that part, but white copier paper copies are still valid)
- Only the English form is the officially mandated/recognized WyoPOLST form
- Do not send any information about bracelets or POLST forms to WDH-AGD (we do not have a central registry or means to process payments)
- We highly recommend use of the Spanish Education Form for Spanish readers/speakers to know what the equivalent English section means
- Print out some brochures and provide to patients so they have a take home easily readable pamphlet to explain what POLST is all about
- Forms need to be at all your medical provider’s offices, and with local EMT’s
- If you are moving out of state for any significant period, it is recommended notifying their local EMT/Medical staff and seeing if they recognize WyoPOLST forms in their state, and if not please make alternative arrangements
- Bracelets are optional for those who wish to purchase them, and simply notify staff that there is a POLST in existence for this patient
- Only StickyJ Bracelets are officially recognized by the State of Wyoming
Educational Materials from National POLST
- On religious considerations during the POLST process: https://polst.org/polst-religion/
- On the eradication of racial injustice from the POLST process: https://polst.org/rejecting-racism/
- Patient guides for conversation with your Primary Care Provider: https://polst.org/national-form/?pro=1
For More Information
For more information about the WyoPOLST program, please contact the WyoPOLST Program Manager at 1-800-442-2766 or email at email@example.com.
Please view our FAQ document for answers to commonly asked questions.
If you are interested in becoming a partner in the WyoPOLST Network please reach out to the Program Manager.