Medical Orders for Life-Sustaining Treatment - Professionals

MOLST Form

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 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 form includes medical orders and patient preferences regarding:

• CPR (cardiopulmonary resuscitation)
• Intubation and mechanical ventilation
• Artificial hydration and nutrition
• Future hospitalization and transfer
• Antibiotics

  DOH-5003 MOLST form
         Copies of the MOLST form should be printed on bright pink paper.

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 health status,
     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.

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 in ALL settings. 

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

The MOLST form was revised in June 2010.