Polst Form Hawaii - Visit www.kokuamau.org/polst to download a copy or find more polst informa椀on. • the decision to create a polst should be discussed with each person’s own provider. The polst form asks for information about your preferences for medical treatments: This form has been adopted by the department of health july 2014 kōkua mau • po box 62155 • honolulu hi 96839 • info@kokuamau.org • www.kokuamau.org This provider order form is based on the person’s current medical condition and wishes. Patient’s last name first/middle name date of birth date form prepared first follow these orders. Web kōkua mau is the lead agency for implementa椀on of polst in hawai‘i. Then contact the patient’s provider.
Visit www.kokuamau.org/polst to download a copy or find more polst informa椀on. Web kōkua mau is the lead agency for implementa椀on of polst in hawai‘i. • the decision to create a polst should be discussed with each person’s own provider. This provider order form is based on the person’s current medical condition and wishes. The polst form asks for information about your preferences for medical treatments: Then contact the patient’s provider. Patient’s last name first/middle name date of birth date form prepared first follow these orders. This form has been adopted by the department of health july 2014 kōkua mau • po box 62155 • honolulu hi 96839 • info@kokuamau.org • www.kokuamau.org