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3181 SW Sam Jackson Pk Rd CDW-EM Portland, OR 97239

Form Registration

How to Register a POLST Form:

Send a copy of the POLST form to:

Fax: 503-418-2161

Mail: 3181 SW Sam Jackson Park Rd, Mail Code: CDW-EM, Portland, OR 97239

 

Step-by-Step Registration

Step 1: Collect all POLST forms ready for submission to the Regsitry

 

Step 2: Compile optional demographics sheets (if applicable).  Providing optional demographics is highly recommended. This information helps expedite patient identification and providing address information allows the Registry to send the patient a confirmation packet.

 

Step 3: Verify that all required elements are present:

  • The patient’s full name
  • Date of birth
  • A physician/NP/PA signature
  • Date signed
  • At least one order section must be completed for entry into the Regsitry*

*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.

 

 

Step 4: Clarify (on the form) any information that may be hard to read

 

Step 5: Fax or mail to Registry

Fax: 503-418-2161

Mail: 3181 SW Sam Jackson Park Rd, Mail Code: CDW-EM, Portland, OR 97239

 

Confirmation of receipt: A confirmation packet will be mailed to the address provided on the POLST, or optional demographics, form. Please allow up to 4 weeks for delivery.

 

eSubmit Registration

eSubmit is the process of setting up a secure File Transfer Protocol (sFTP) connection with the Registry to electronically submit POLST form PDF’s and/or electronic POLST form data.

 

This service is available to health care entities wishing to electronically transfer files to the Registry.  For more information, please review and complete the: OPR electronic submissions user agreement.  

 

Completed ‘eSubmit Initiation request’ form should be submitted via fax (listed above), or e-mail to polstreg@ohsu.edu