Compassion and Support

Professionals

Patients & Families

Medical Orders for Life Sustaining Treatment - Professionals

Frequently Asked Questions (FAQs)

Due to the significant change in procedures and decision-making standards set forth in the Family Health Care Decisions Act (FHCDA), the legal requirements to withhold and/or withdraw life-sustaining treatment have changed.  As a result, these changes are integrated into the MOLST Process.  This has raised many questions among professionals.  Printable PDF of MOLST FAQs page 1 and page 2.

These questions and answers are approved by the New York State Department of Health and posted on their website (April 2012). 


What do you do with a completed MOLST form?

MOLST forms are designed to travel with the individual between care settings.

  • In a Facility - The form should be kept in the front of the individual's medical chart when the individual is in a facility. 
  • At Home - When the individual is at home, the MOLST form should be kept on the refrigerator, by the phone in the kitchen, or by the individual's bedside.  In case of emergency, EMS personnel are trained to look for the MOLST form in these locations.
  • Care Transitions - A photocopy of the MOLST form should be made when the individual is transferred from one healthcare setting to another (e.g., being admitted from a nursing home to a hospital).  The photocopy of the form should be kept in the medical chart at the original location at the time of care transition.  The original form should accompany the individual can be placed in the individual's medical chart at the new care setting.
When must the MOLST be reviewed?

The physician must review the MOLST form from time to time as the law requires, and also:

  • If the patient moves from one location to another to receive care; or
  • If the patient has a major change in health status (for better or worse); or
  • If the patient or other decision-maker changes his or her mind about treatment.

DNR/Allow Natural Death orders:  Public Health Law requires the physician to review non-hospital DNR orders and record the review at least every 90 days.  In hospitals and nursing homes, MOLST orders must be reviewed regularly in accordance with facility policies.

Life-Sustaining Treatment orders:  The patient's medical condition, prognosis, values, wishes and goals for his/her care may change over time.  The physician should review these orders at the same time as DNR/Allow Natural Death orders are reviewed and the review is recorded. 

How should MOLST orders be reviewed and renewed?

Review all medical orders in Section A through E of the MOLST form.

Document the outcome of the review in Section F

  • If there is no change in the patient's health status, medical decision-making capacity or preferences, sign,
    date and check the "No Change" box.
  • If there is a substantial change in patient's health status, medical decision-making capacity, goals for care
    or preferences that results in a change in MOLST orders, write "VOID" in large letters on pates 1 and 2, and
    complete a new form, in accordance with NYSPublic Health Law decision-making standards and procedures.
    Check box marked "FORM VOIDED, new form completed".  (RETAIN voided MOLST form in chart, medical
    record, or electronic registry as required by law.)
  • If this form is voided and no new form is completed, full treatment and resuscitation will be provided, unless
    a different decision is made by the patient, surrogate or health care agent.  Write "VOID" in large letters on
    pages 1 and 2 and check box marked "FORM VOIDED, no new form."  (RETAIN voided MOLST form in chart,
    medical record, or electronic registry as required by law.)
Can MOLST orders be changed by a patient?

A patient with capacity to make medical decisions regarding life-sustaining treatment may revoke his or her consent to MOLST orders and may ask his/her physician to change them.  If the patient lacks capacity to make health care decisions and there is a change in the goals for care based on a major change in health status, the Health Care Agent or Surrogate may also revoke consent and may request a change in the MOLST.  The patient, Health Care Agent or Surrogate must be consulted about any changes recommended by the patient's health care provider.

Are MOLST orders legal and valid as patients move across care settings?

MOLST orders completed in accordance with New York law remain valid when the patient transitions from one health care setting to another.  Non-hospital DNR orders, including those with a MOLST form, must be reviewed by a physician at least every 90 days.  In addition, all MOLST orders must be reviewed consistent   with facility policy and when the patient transitions between care settings, when there is a major change in health status, and when the patient or other health care decision-maker changes his/her mind about treatment.

Why is the MOLST form bright pink?

Printing the form on bright "pulsar" pink, heavy stock paper is strongly encouraged.  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 representation of the original, signed MOLST are legal and valid. 

How can the pinkness of the MOLST form be maintained?

When the patient is transferred between care settings, a copy of the form should be made on Pulsar Pink paper.  The original MOLST form should accompany the patient and be placed in the chart in the new care setting or placed on the refrigerator at home.

Is a white copy of the original, signed MOLST form legal and valid

 Yes.  White MOLST forms and photocopies, faxes, or electronic representations of the original, signed MOLST are legal and valid.

Is a photocopy of the original, signed MOLST form legal and valid?

Yes.  White MOLST forms and photocopied, faxes, or electronic representations of the original, signed MOLST are legal and valid.

Is a facsimile (fax) of the original, signed MOLST form legal and valid?

Yes.  White MOLST forms and photocopied, faxes, or electronic representations of the original, signed MOLST are legal and valid.

Is an electronic representation of the original, signed MOLST form legal and valid?

Yes.  White MOLST forms and photocopied, faxes, or electronic representations of the original, signed MOLST are legal and valid.

Is a stamped signature on the original, signed MOLST form legal and valid?

No.  A stamped signature is not permitted.

How should a MOLST form be used in a facility with electronic health records?

Scan the MOLST into the computer at the time of admission and discharge.  Review the MOLST at the  time of discharge or transition of care and retain an electronic copy.  The original pink MOLST form should be given to the patient at the time of discharge.  A copy should be retained in the electronic medical record, a copy should go to the primary care physciain's office and a copy should go to home care agency if the patient has home care.

Is an electronic version of MOLST (eMOLST) available?

As a result of New York State Department of Health HEAL 5 (Health Care Efficiency and Affordability) grant, a secure web-based application will render an electronic version of the current paper-based New York State Department of Health-5003 MOLST form that is available to providers through the Rochester Regional Health Information Organization (RHIO).  Integration with the Rochester RHIO will attach signed eMOLST forms to the XDS.b registry.

In keeping with New York State's vision for open-system solutions, the eMOLST application is being developed following open architectural principles for the benefit of the community and other RHIOs across the state.  The long range goal is to develop a New York State MOLST Registry, through working with all RHIO's statewide.  A mobile application is available to support many eMOLST functions.

The eMOLST application documents the clinical process, including goals for care discussion, as well as the legal requirements.  The eMOLST application upgrades the workflow around completing the information required for a legal medical order with automated user feedback for quality review and notification of missing information and training tools for users.  A DOH-5003 MOLST form and a MOLST Chart Documentation Form for adult or minor patients or OPWDD checklist for individuals with developmental disabilities who lack medical decision-making capacity are created.

By moving the MOLST form to a readily accessible electronic format, health care providers, including EMS, will have access to MOLST forms at all sites of care including hospitals, nursing homes and the community.  This approach will allow for EMS to view in the event of an emergency and will allow for other systems to view at the time of need, as the document is shared across the care continuum.

Does the MOLST form replace traditional Advance Directives?

No.  A properly completed MOLST form contains legal and valid medical orders.  It is not intended to replace traditional advance directives like the health care proxy and living will.

Can the MOLST take the place of current DNR forms in health care facilities?

Yes.  In October 2005, New York State Department of Health (NYSDOH)  approved the physician order form, the Medical Orders for Life-Sustaining Treatment (MOLST), as a physician order form, the Medical Orders for Life-Sustaining Treatment (MOLST), as a Do Not Resuscitate (DNR) form that can be used in any setting.

On January 11, 2006 NYSDOH sent a letter introducing the MOLST to all health care facilities throughout the New York State.

NYSDOH updated the MOLST form June of 2010 to make it more user-friendly and to align the form with the Family Health Care Decisions Act (FHCDA) and other provisions of Chapter 8 of the Laws of 2010 that went into effect June 1, 2010.

Where can I get MOLST forms?

MOLST forms can be downloaded from the NYSDOH web site or at CompassionAndSupport.org.

The MOLST form should be printed on bright "pulsar" pink, heavy stock paper.  Hard copies of the card stock pink form (with all four pages printed landscape/double-sided on a single 11" x 17" sheet folded in the middle) can be ordered using a form that can be downloaded from CompassionAndSupport.org.

 Where can I get more information about MOLST?

For more information about the MOLSt Porgram, view the Department of Health's web site and the Compassion and Support web site. Professionals section on MOLST and the MOLST Training Center at www.CompassionAndSupport.org.

Where can I get more information about MOLST?

For more information about the MOLST Program, view the Department of Health's website and the Compassion and Support website, Professionals section on MOLST and the MOLST Training Center at www.CompassionAndSupport.org.

to top