Medical Orders for Life-Sustaining Treatment - Professionals
How to Complete a MOLST Form
MOLST must be completed by a health care professional, based on patient preferences and medical indications. Health care professionals should be trained, competent and comfortable with having the conversation with the 8-Step MOLST Protocol.Conversations between the health care professional and patient should be shared with the Health Care Agent and family to ensure the Health Care Agent and family are aware of the patient’s wishes and to avoid future conflict. Conflict arises when the wrong person is chosen as the Health Care Agent or if there is no antecedent conversation. Document the conversation in the medical record.
1.The MOLST form must be signed by a New York State-licensed physician to be valid. Verbal orders are acceptable with follow-up signature by a physician in accordance with facility/community policy.
2.If the individual has a legal and valid DNR previously completed while the individual had capacity, attach it to the MOLST form.
3. Use of the original form is strongly encouraged. The readily-identifiable pink color makes it easier to find in case of an emergency. Photocopies and faxes of signed MOLST forms are acceptable and legal.
4.Completion of the entire form is strongly recommended. Review of the entire form serves to educate the patient regarding additional choices for life-sustaining treatment. Any section not completed implies full treatment for that section.
5.Consent for DNR must be obtained and documented in Section B of Page 1. Consent can be provided by the patient, resident, a duly appointed Health Care Agent or proxy or surrogate decision-maker, in accordance with NYS Public Health law (PHL § 2977):
- An individual with capacity (the ability to make health care decisions) can provide their own consent.
- If the individual lacks capacity and has a designated Health Care Agent or proxy, then the Health Care Agent or proxy can provide consent for the individual.
- If the individual lacks capacity and does not have a designated Health Care Agent or proxy, then the surrogate must be selected from the following list [in order of priority with a) as the highest priority and h) as the lowest priority]:
a) Designated Health Care Agent
b) Court-appointed committee or guardian
c) Spouse
d) Son or daughter, age 18 or older
e ) Parent
f) Bother or sister, age 18 or older
g) Close friend of the person, age 18 or older (affidavit of close friend required)
h) No appropriate surrogate decision-maker is available
6. Consent for ‘Orders for Life-Sustaining Treatment and Future Hospitalization’ should be obtained and documented in Section E of Page 2.
- An individual with capacity (the ability to make health care decisions) can provide their own consent.
- If the individual lacks capacity and has a designated Health Care Agent or other designated decision-maker, then the Health Care Agent or other designated decision-maker can provide consent for the individual.
- If the individual lacks capacity and does not have a designated Health Care Agent or other designated decision-maker, then “clear and convincing evidence” of the individual’s preferences is required in the form of an Advance Directive or repeated oral expression. Confirmation of the person’s treatment preferences must be obtained and documented in the consent for Section E.
