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Introduction to the POLST Form

www.health.pa.gov

FIRST follow these orders, THEN contact physician, certified registered nurse practitioner or physician assistant. This is an Order Sheet based on the This is an Order Sheet based on the person’s medical condition and wishes at the time the orders were issued.

  Sheet, Order, Physician, Order sheet

Order Sheet - GasAlertMicroClip XT

www.gasalertmicroclipxt.com

Wear yellow. Work safe. Standard Package Contents • GasAlertMicroClip XT • Charger wall plug • Calibration cap and tubing • Manual, materials booklet and technical

  Sheet, Order, Order sheet

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