Medical Orders for Life-Sustaining Treatment - Professionals

MOLST Form

The Medical Orders for Life-Sustaining Treatment (MOLST) is a bright pink medical order form signed by a New York State licensed physician that communicates patient wishes regarding life-sustaining treatments to health care providers. The form includes medical orders and patient preferences regarding:

1. CPR (cardiopulmonary resuscitation)

2. Intubation and mechanical ventilation

3. Artificial hydration and nutrition

4. Future hospitalization and transfer

5. Antibiotics

  Download a printable sample of the MOLST form

View Explanations of the August 2008 Revisions to the MOLST Form

View a printable sample of the MOLST Form with August 2008 Edits in Red

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

1. The individual has given significant thought to life-sustaining treatments.

2. The health care professional has discussed current medical condition, prognosis and treatment options including life-sustaining treatments with the individual.

3. The individual has communicated his/her personal preferences regarding life-sustaining treatments to the physician.

If the individual desires, 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.

MOLST is approved by the New York State Department of Health (NYSDOH) for use as an inpatient DNR in all hospitals and long- term care facilities.

Although, the MOLST form summarizes advance directives, it is not intended to replace traditional advance directives such as the Health Care Proxy form and/or Living Will.

Health Care Proxy / Living Will		MOLST
-- For all adults		-- For those who are chronically ill or nearing the end of their lives
-- Completed ahead of time		-- Applies Right Now
-- Applies only when decision-making capacity is lost		--Not conditional on losing decision-making capacity
		-- Contains actionable medical orders

The MOLST form was revised in October, 2005. To view a list of the 2005 revisions to the form, please click here [pdf]