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Provider Orders for Life-Sustaining Treatment (POLST) AFT

Minnesota Provider Orders for Life-Sustaining Treatment (POLST). www.mnpolst.org PAGE 2 OF 2 INFORMATION FOR PATIENT NAMED ON THIS FORM NOTE TO PATIENTS AND SURROGATES The POLST form is always voluntary and is for persons with advanced illness or frailty. POLST records your wishes for medical treatment in your current state of health.

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  Treatment, Life, Minnesota, Sustaining, For life sustaining treatment

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