Introduction to the California POLST Form

POLST is a physician order that gives patients more control over their care during serious illness. Produced on a distinctive bright pink form and signed by both the physician and patient, POLST specifies the types of medical treatment that a patient wishes to receive towards the end of life.

The signed POLST form must be in English so that emergency personnel can read and follow the orders.

For questions in English, email
info@coalitionccc.org or call (916) 489-2222. To learn more about POLST, visit www.caPOLST.org.

Click to Download POLST Form (Simplified)
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Click to Download POLST Form (Traditional)
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California Advance Healthcare Directive

An Advance Health Care Directive allows you to state what kind of healthcare you want if you ever become very sick and are unable to speak for yourself. This way, those who care for you will not have to guess what you want if you are too sick to tell them yourself.

WHO WE ARE
The Chinese American Coalition for Compassionate Care, the only coalition in the nation devoted to end-of-life concerns in the Chinese community, is an active working coalition of 48 Partner Agencies and over 1,300 individual members.

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