The National POLST Paradigm improves the quality of care for patients who are seriously ill or frail by creating a system that elicits, documents and honors patient medical treatment wishes through portable medical orders. The POLST Paradigm is part of advance care planning, a process that includes conversations between patients and health care professionals about goals of care and quality of life. Everyone is encouraged to complete an advance directive but to recognize its limitation: advance directives are not medical orders so emergency personnel cannot follow during a medical emergency. Instead, once the patient is in the hospital and stabilized, the health care team works with the surrogate identified in the advance directive and reviews the patient wishes to develop a treatment plan. With a POLST Paradigm Form, the treatment plan is developed in advance and moved upstream; the medical orders on the form give clear instructions to emergency personnel about whether the patient wanted CPR and whether they wanted to go to the hospital or remain where they are. The POLST Paradigm is always voluntary and should be available to all seriously ill or frail individuals.