Medical Orders for Life-Sustaining Treatment - Professionals

MOLST Program

Surveys have shown that people are not dying in the setting of their choice, most do not have advance directives in place, the majority of those being referred to hospice arrive too late to fully benefit, and most fear dying in pain and without dignity or control.

The Medical Orders for Life-Sustaining Treatment (MOLST) is designed to improve the quality of care people receive at the end of life.  MOLST is New York State's Physicians Orders for Life-Sustaining Treatment (POLST) Paradigm Program.  These programs are based on effective communication of patient wishes, documentation of medical orders on a brightly colored form, and a promise by health care professionals to honor these wishes.  See if your state has a POLST Paradigm Program.

The MOLST Program

• Assists health care professionals in discussing and developing treatment plans that reflect patient wishes. 
• Results in the completion of the MOLST form.  
• Helps physicians, nurses, health care facilities and emergency personnel honor patient wishes regarding life-sustaining treatments.

MOLST is generally for patients with serious health conditions.  Physicians should consider consulting with the patient about completing a MOLST form if the patient:

• Wants to avoid or receive life-sustaining treatment.
• Resides in a long-term care facility or requires long-term care services.
• Might die within the next year.

NYS MOLST Form

•  DOH-5003 MOLST form 
• Printing the MOLST form on bright "pulsar" pink, heavy stock paper is strongly encouraged.
• Astrobrights Pulsar Pink 24lb paper is available through Office Depot, Staples, Office Max, and other paper suppliers. 
• When EMS personnel respond to an emergency call in the community, they are trained to check whether the patient has a pink MOLST form before initiating life-sustaining treatment.  They might not notice a MOLST form on plain white paper.
• However, white MOLST forms and photocopies, faxes, or electronic representations of the original, signed MOLST are legal and valid.
•  Spanish version of the MOLST form for educational purposes ONLY.

Key Resources

• View MOLST on NYSDOH
• DOH-5003 MOLST form
• MOLST for Patients & Families
• MOLST Training Center
• MOLST and Family Health Care Decisions Act (FHCDA)
• MOLST Instructions and Legal Requirements Checklists for Adult Patients
• MOLST Chart Documentation Forms for Adult Patients (1 - 5)
• MOLST Instructions and Legal Requirements Checklist for Minor Patients
• MOLST Chart Documentation Form for Minor Patients
• MOLST Instructions and Legal Requirement Checklist for Patients with Developmental Disabilities who Lack Medical Decision-Making Capacity
• MOLST Instructions and Legal Requirements Checklists for Patients with Mental Illness in a Mental Hygiene Facility
• MOLST and FHCDA Webinar Series
• Capacity Determination
• Myths and Truths of CPR
• Guidelines for Long Term Feeding Tube Placement
• Other State Specific Forms
• Electronic Registry - POLST Paradigm Programs
  • New York State eMOLST
  • Oregon POLST Registry

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