Compassion and Support


Patients & Families

Medical Orders for Life-Sustaining Treatment - Professionals


The MOLST form is a medical order form that tells others the patient's medical orders for life-sustaining treatment.  All health care professionals must follow these medical orders as the patient moves from one location to another, unless a physician examines the patients, reviews the orders, and changes them.

MOLST is approved by the New York State Department of Health (NYSDOH) for use in ALL settings.  The NYSDOH revised the MOLST form in June 2010 to align with Family Health Care Decisions Act.

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.

The MOLST form must be completed based on the patient's current medical condition, values, wishes, and these MOLST instructions.  Completion of the MOLST begins with a conversation or a series of conversations between the patient, the health care agent or the surrogate, and a qualified, trained health care professional that defines the patient's goals for care, reviews possible treatment options on the entire MOLST form, and ensures shared, informed medical decision-making.  The conversation should be documented in the medical record.

Although the conversation(s) about goals and treatment options may be initiated by any qualified and trained health care professional, a licensed physician must always, at a minimum:

  • Confer with the patient and/or the patient's health care agent or surrogate about the patient's diagnosis, prognosis, goals for care, treatment preferences, and consent by the appropriate decision-maker.
  • Sign the orders derived from that discussion

If the physician is licensed in a border state, the physician must insert the abbreviation for the state in which he/she is licensed, along with the license number.

The form includes medical orders and patient preferences regarding

  • Resuscitation instructions when the patient has no pulse and/or is not breathing
    • CPR order (Attempt CPR) or DNR order (Allow Natural Death)
  • Orders for other life-sustaining treatment and future hospitalization when the patient has a pulse and the patient is breathing
    • Treatment guidelines
    • Intubation and mechanical ventilation
    • Artificially administered fluids and nutrition
    • Future hospitalization and transfer
    • Antibiotics
    • Other Instructions


  •  DOH-5003 MOLST form 
  • Printing the MOLST form on bright "pulsar" pink, heavy stock paper is strongly encouraged, but NOT required for the form to be legal and valid.
  • Astrobrights Pulsar Pink 65lb paper is available through 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 DOH-5003 MOLST form is for educational purposes ONLY

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 seriously 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
 --NOT actionable medical orders   -- Contains actionable medical orders

For more information on MOLST, view MOLST for Professionals and NYSDOH and MOLST.

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