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Medical Orders for Life Sustaining Treatment - Patients & Families

MOLST Form

The Medical Orders for Life-Sustaining Treatment (MOLST) form is a medical order form that tells others the patient’s wishes for life-sustaining treatment. A health care professional must complete or change the MOLST form, based on the patient’s current medical condition, values and wishes, and MOLST Instructions. If the patient is unable to make medical decisions, the orders should reflect patient wishes, as best understood by the health care agent or surrogate. A physician must sign the MOLST form. All health care professionals must follow these medical orders as the patient moves from one location to another, unless a physician examines the patient, reviews the orders and changes them.

MOLST is based on the individual’s current medical condition and wishes. MOLST should be completed only after the individual has:

  • Given significant thought to life-sustaining treatments
  • Discussed life-sustaining treatments, current medical condition, prognosis and treatment options with his/her physician
  • Communicated his/her personal preferences regarding life-sustaining treatments to the physician.

Depending on the individual’s preferences, a physician uses the MOLST to record orders for Do Not Resuscitate (DNR), Do Not Intubate (DNI), and/or other life-sustaining treatments. The MOLST form centralizes information on these issues, improves record keeping, and transfers appropriate information between health care professionals and between care settings.

The MOLST form is on bright pink paper so health care professionals can identify it in case of an emergency.

Although, MOLST summarizes advance directives, it is not intended to replace the advance directives (i.e., Health Care Proxy form and/or Living Will).


Download a printable DOH-5003 MOLST form.
        A copy of the form on white paper is legal and valid.  The reason to send a copy and retain the original is
        to prevent the original from being lost in a patient's transfer from one healthcare copy possible.

 Spanish version of the MOLST form for educational purposes ONLY.

If a patient lacks capacity or ability to make health care decisions, additional consideration is needed.  Please view the following:                          

  • Capacity Determination

     

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