3181 SW Sam Jackson Pk Rd BTE234 Portland, OR 97239

HIM and Clinic Staff

How do we submit forms to the Registry? Fax, mail, or esubmit a copy of the patient’s current POLST form (front and back) to the Registry office.  Be sure to include a coversheet when faxing.  If you would like to submit forms through another electronic submission process contact the Registry business office for more information. *please do not use staples. 


What information is required for the POLST form to be entered into the Registry?

» The patient’s full name

» Date of birth

» A physician/NP/PA/ND signature*

» Date signed

» At least one order section must be  completed for entry into the Registry** 


*”Signed” means a physical signature, electronic signature or verbal order documented per standard medical practice. Refer to OAR 333-270-0030


**The Registry cannot accept POLST forms marked “Resuscitate” (Section A) and “Comfort Measures Only” (Section B). These orders cannot be interpreted by EMS. Additional information can be found in the Oregon POLST Program’s, Guidance for Oregon’s Health Care Professionals.


Do all POLST forms need to be submitted? No. POLST forms signed on or after Dec 3, 2009 are required to be submitted (unless the patient wishes to opt-out). Forms signed prior to this date may be voluntarily submitted to the Registry if the patient’s address is included. This ensures that the patient will receive a Registry confirmation packet and has an opportunity to opt-out. Any time an updated POLST form is received for a patient it should be submitted to the Registry.


Why are forms being sent back? Forms that have missing or illegible information that prevent them from being entered into the Registry are sent back to the sender for clarification. The most common reasons for a form to be sent back are missing or illegible physician/NP/PA signature and/or date of signature.


What is the POLST Registry ID? It is a unique identifier assigned to a patient. You may see this ID printed on a magnet or sticker. You can request this ID along with any POLST forms your office submits. We recommend including this ID in the patient’s chart for reference when contacting the Registry.


Can my office request a copy of a POLST form from the Registry? Yes! The Registry business office is happy to provide copies of registered POLST forms to health care professionals and hospital HIM departments. To request a copy of a POLST form, simply contact the business office, and provide documentation (required) indicating the patient is in the care of your institution. A Registry staff member will then send a copy of the requested POLST to your secure fax within 1 business day. Large requests, for multiple patients’ POLST forms,  may require additional time.


Additional Resources:

Frequently Asked Questions: HIM Depts and Clinic Staff

Information for Hospital HIM Depts and Clinic Support Staff (PowerPoint)

OPR eSubmit Initiation Request

OPR Brochure for Patients

OPR Demographic Information Form

Registry ID Request Cover Sheet

POLST Registry Quick Reference Guide

House Bill 2009 Enrolled Condensed

Oregon Administrative Rules 333-270