South Carolina Physician Orders for Scope of Treatment (POST) Act FAQs
What are advance care planning and advance directives?
Advance care planning (ACP) refers to the making of decisions by a person about the care the person wants to receive, if the person becomes unable to communicate or consent to care and the documentation of those decisions by acceptable methods recognized by the State.
Advance directive means a written statement such as a health care power of attorney, executed in accordance with S.C. Code Ann. § 62-5-504, in which an individual expresses certain wishes relating to life-sustaining treatment, including resuscitative services, for potential future care. An advance directive is not a medical order, whereas POST is a medical order.
What is a POST?
POST stands for Physician Orders for Scope of Treatment and is not an advance directive. A POST form is a designated document designed for use as part of advance care planning (ACP) and consists of a set of medical orders signed by a patient’s physician, advanced practice registered nurse (APRN), or physician assistant (PA) addressing key medical decisions consistent with patient goals of care concerning treatment at the end of life that is portable and valid across health care settings.
What patient wishes does the POST form address?
The POST form includes orders concerning a patient’s CPR preference, medical intervention preferences, preferences for antibiotics, and assisted nutrition and hydration preferences.
Who can have a POST?
The use of a POST form is limited to situations where the patient has been diagnosed with a serious illness or, based upon medical diagnosis, may be expected to lose capacity within twelve months. Serious illness means a condition which, based upon best medical judgment, is likely to result in death within a period that does not exceed twelve months.
When should a POST form be completed?
The POST form should be completed after discussion with a trained facilitator or qualified healthcare professional as well as discussion with and review by a physician, advanced practice registered nurse (APRN) (if authorized to do so by his or her practice agreement), or physician assistant (PA) (if authorized to do so by his or her scope of practice guidelines). The patient and physician/APRN/PA should agree the POST is an appropriate tool for making sure the patient’s wishes are known. A POST is not considered executed until it is completed and signed and dated by both the patient (or legal representative) and physician/APRN/PA.
Where should a POST form be stored?
A POST form is a set of medical orders that is portable and valid across health care settings. The original POST form should be given to the patient and should accompany a patient upon admission to, or admission or discharge from, a health care facility. The POST form should also be available for emergency medical technicians transporting a patient. A copy of the POST form should also be included in the health care facility’s electronic health/medical record.
Must I have the original POST form for it to be legally effective?
No. A copy, facsimile, or electronic version of a completed POST form is considered to be legal.
Will all health care providers and facilities follow the wishes expressed in the POST form?
A South Carolina health care provider or health care facility may accept a properly executed POST form as a valid expression of whether the patient consents to the provision of health care in accordance with Section 44-66-60 of the Adult Health Care Consent Act.
Since POST is a medical order, health care providers and health care facilities should implement the medical order, or allow the transfer of the patient.
A health care provider or health care facility that is unwilling to comply with an executed POST form based on policy, religious beliefs, or moral convictions shall contact the patient (if the patient has decision making capabilities and is able to communicate), or the patient’s health care representative, health care agent, or the person authorized to make health care decisions for the patient pursuant to Section 44-66-30 of the Adult Health Care Consent Act, and the health care provider or health care facility shall allow the transfer of the patient to another health care provider or health care facility.
Are other states using forms like POST?
Yes. According to the national POLST Paradigm, POST exists at some level in 50 states and Washington D.C. The POLST Paradigm goes by different names in different states. Information about the national POLST paradigm can be found at https://polst.org/.
Is the South Carolina POST form valid in other states?
This depends on the state. Go to https://polst.org/ and check with the state program.
Are out of state POST forms valid in South Carolina?
A POST form executed in South Carolina as provided in the POST Act, or a similar form executed in another jurisdiction in compliance with the laws of that jurisdiction must be deemed a valid expression of a patient’s wishes as to health care.
Is a POST form mandatory?
No. Execution of a POST form is voluntary. A health care provider, health care facility, health care service plan, insurer issuing disability insurance, self-insured employee benefit plan, or nonprofit hospital plan may not require any person to execute a POST form as a condition of being insured for, or receiving, health care services.
How long is a POST form valid?
An executed POST form remains effective until revoked or until a new POST form is executed. Any physician who is responsible for the creation and execution of a POST form shall make reasonable efforts to periodically review and update the POST form with the patient as the patient’s needs dictate but at least once per year.
How can I revoke a POST form?
A POST form may be revoked at any time by an oral or written statement by the patient or a patient’s legal representative. A revocation is only effective upon communication to the health care provider or health care facility by the patient or the patient’s legal representative. The execution of a POST form by a patient, or the patient’s legal representative automatically revokes any previously executed POST form.
What is the liability for health care providers who in good faith comply with a POST form?
A health care provider including, but not limited to, a physician, physician assistant, advance practice registered nurse, registered nurse, or emergency medical technician, who in good faith complies with a POST form, is not subject to criminal prosecution, civil liability or disciplinary penalty for complying with the POST form executed in accordance with the POST Act and the Adult Health Care Consent Act.
What is a Do Not Resuscitate (DNR) order?
See DHEC’s EMS DNR order FAQs.
What if a section of the POST form is left blank with no choice being made?
According to the national POLST Paradigm, any incomplete section of the POST form creates no presumption about patient’s preferences for treatment. Provide standard of care.
NOTHING IN THESE FAQS SHALL BE CONSTRUED AS LEGAL ADVICE.