The Oregon POLST RegistryInformation for patients and families

What is the Oregon POLST Registry• It is a secure electronic record of

your POLST orders

•The Registry allows emergency medical professionals access to your POLST orders if the original POLST form cannot be found

•The Registry is a back-up system and does not replace your original POLST form

How does the Registry work?

• If, in an emergency, your POLST form cannot be immediately found, emergency medical professionals can call the Registry to obtain your orders

How will the Registry get my form?•The health care professional who signed your

form is required to submit your form to the Registry (unless you opt-out)

•You can also fax or mail a copy of your form to the Registry:▫Registry fax: 503-418-2161▫Oregon POLST Registry 3181 SW Sam Jackson Park Rd

CDW-EM Portland, OR 97239

What if I don’t want my information in the Registry?

• If you don’t want your information in the Registry simply check the ‘opt-out’ box on your form

• If your form was entered into the Registry and you would like it removed, contact us! ▫Phone: 503-418-4083▫Toll free: 877-367-7657▫E-mail: polstreg@ohsu.edu▫Submit a web request: www.orpolstregistry.org

How will I know my form is in the Registry?•A confirmation letter will be mailed to you if mailing

address information was included with your POLST form.

•Your confirmation packet will contain a Oregon POLST Registry magnet and set of stickers with your unique Registry ID printed on them ▫The Registry ID is unique and helps identify your form

in the Registry, please refer to this ID any time you call the Registry

Confirmation letter•To the right is an example

of a confirmation letter

•The letter includes:▫Your Registry ID▫A synopsis of your

section A and section B orders

▫Information on how to contact the Registry

Registry Magnets and Stickers•The magnet and stickers are used to

alert health care professionals that you have a POLST form on file with the Registry

•POLST Registry magnets and stickers do not replace the original POLST form

Where do I put my magnet and stickers?•The Registry magnet (example right)

should be placed on your refrigerator

• It is recommended that you place your stickers:▫On your original POLST form▫On something you carry with you

(ex. your wallet)▫The third can be given to your

primary care provider

Can I get additional magnets and stickers?•Yes! The Registry office is happy to provide you with

additional magnets, stickers, and even copies of your POLST form

•To request additional materials:▫Phone: 503-418-4083▫Toll free: 877-367-7657▫E-mail: polstreg@ohsu.edu▫Submit a web request: www.orpolstregistry.org

Contact the Registry:

•When your POLST orders change

•When your personal information changes (address, name, etc.)

•When you have questions about the Registry

877-367-7657 We are here to help!

How to contact the Registry

•Phone: 503-418-4083•Toll free: 877-367-7657•Fax: 503-418-2161•E-mail: polstreg@ohsu.edu•Website: www.orpolstregistry.org