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      LAST NAME FIRST NAME MIDDLE NAME DATE OF BIRTH ________________________________________________________________________________________________________________________________________
COMPLETING LaPOST
DIRECTIONS FOR HEALTH CARE PROFESSIONALS
• Must be completed by a physician and patient or their personal health care representative based on the patient’s medical conditions and preferences for treatment.
• LaPOST must be signed by a physician and the patient or PHCR to be valid. Verbal orders are acceptable from physician and verbal consent may be obtained from patient or PHCR according to facility/community policy.
• Use of the brightly colored original form is strongly encouraged. Photocopies and faxes of signed LaPOST are legal and valid. USING LaPOST
• Completing a LaPOST form is voluntary. Louisiana law requires that a LaPOST form be followed by health care providers and provides immunity to those who comply in good faith. In the hospital setting, a patient will be assessed by a physician who will issue appropriate orders that are consistent with the patient’s preferences.
• LaPOST does not replace the advance directive. When available, review the advance directive and LaPOST form to ensure consistency and update forms appropriately to resolve any conflicts.
• The personal health care representative includes persons described who may consent to surgical or medical treatment under RS 40:1159.4 and may execute the LaPOST form only if the patient lacks capacity.
• If the form is translated, it must be attached to a signed LaPOST form in ENgLISH.
• Any section of LaPOST not completed implies full treatment for that section.
• A semi-automatic external defibrillator (AED) should not be used on a person who has chosen “Do Not Attempt Resuscitation”.
• Medically assisted nutrition and hydration is optional when it cannot reasonably be expected to prolong life, would be more burdensome than beneficial or would cause significant physical discomfort.
• When comfort cannot be achieved in the current setting, the person, including someone with “Comfort focused treatment,” should be transferred to a setting able to provide comfort (e.g. pinning of a hip fracture).
• A person who chooses either “Selective treatment” or “Comfort focused treatment” should not be entered into a Level I trauma system.
• Parenteral (IV/Subcutaneous) medication to enhance comfort may be appropriate for a person who has chosen “Comfort focused treatment.”
• Treatment of dehydration is a measure which may prolong life. A person who desires IV fluids should indicate “Selective treatment” or “Full treatment.”
• A person with capacity or the personal representative (if the patient lacks capacity) can revoke the LaPOST at any time and request alternative treatment based on the known desires of the individual or, if unknown, the individual’s best interests.
• Please see links on www.La-POST.org for “what my cultural/religious heritage tells me about end of life care.”
The duty of medicine is to care for patients even when they cannot be cured. Physicians and their patients must evaluate the use of technology available for their personal medical situation. Moral judgments about the use of technology to maintain life must reflect the inherent dignity of human life and the purpose of medical care.
REVIEWING LaPOST
This LaPOST should be reviewed periodically such as when the person is transferred from one care setting or care level to another, or there is a substantial change in the person’s health status. A new LaPOST should be completed if the patient wishes to make a substantive change to their treatment goal (e.g. reversal of prior directive). When completing a new form, the old form must be properly voided and retained in the medical chart.
To void the LaPOST form, draw line through “Physician Orders” and write “VOID” in large letters. This should be signed and dated. REVIEW OF THIS LaPOST FORM
  REVIEW DATE AND TIME
  REVIEWER
  LOCATION OF REVIEW
  REVIEW OUTCOME
           No Change
 Form Voided and New Form Completed
       No Change
 Form Voided and New Form Completed
           No Change
 Form Voided and New Form Completed
       No Change
 Form Voided and New Form Completed
        No Change
 Form Voided and New Form Completed
           No Change
 Form Voided and New Form Completed
  SEND FORM WITH PERSON WHENEVER TRANSFERRED OR DISCHARGED
USE OF ORIGINAL FORM IS STRONGLY ENCOURAGED. PHOTOCOPIES AND FAXES OF SIGNED LaPOST FORMS ARE LEGAL AND VALID.
V2.06.13.2016
 
























































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