Compassion and Support

Professionals

Patients & Families

Medical Orders for Life-Sustaining Treatment - Professionals

When to Review and Renew a MOLST Form

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

  • If the patient is moved 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.
  • For residents of OPWDD and OMH facilities, the physician must review the MOLST order at least every 60 days.

 Life-Sustaining Treatment orders

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

Renewal orders must be signed by a New York Stated licensed physician.  The outcome of the review will result in

  • No change
  • Form voided, new form completed
  • For voided, no new form

NOTE - This order remains valid and must be followed, even if it has not been reviewed within the appropriate time period. Under New York State law, this order should be considered valid unless it is known that it has been revoked.

Completing a new form is NOT required every time the MOLST form is reviewed and renewed. If an update is needed, it can be recorded in the appropriate section of the form.

It is the responsibility of the physician to determine, within the appropriate period of time, whether the orders contained on the MOLST form continue to be appropriate.  The physician must document this in the individual’s medical chart and sign the renewal orders located on pages 3 and 4 of the MOLST form.

NYS MOLST Form

  •  DOH-5003 MOLST form 
  • Printing the MOLST form on bright "pulsar" pink, heavy stock paper is strongly encouraged.
  • Astrobrights Pulsar Pink 24lb paper is available through Office Depot, Staples, Office Max, 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.

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

to top