Medical Orders for Life Sustaining Treatment (MOLST)
- Letter is available in Portable Document Format (PDF)
January 17, 2006
Dear Chief Executive Officer:
Honoring patient preferences is a critical element in providing quality end–of–life care. To enable physicians and other health care providers to discuss and convey a patient´s wishes regarding cardiopulmonary resuscitation (CPR) and life–sustaining treatment, the Department of Health has approved a physician order form, the Medical Orders for Life Sustaining Treatment (MOLST), that can be used statewide by health care providers and facilities as the legal equivalent of an inpatient Do Not Resuscitate (DNR) form.
MOLST was created by the Community–wide End of Life Palliative Care Initiative to provide a single document that would function as an actionable medical order and could transition with a patient through all health care settings. It is intended that the form will be transported with the patient between different health care settings in order that their wishes for life–sustaining treatment and CPR will be clearly indicated.
As a result of the Department´s approval, the MOLST form may be used in health care settings, including hospitals and nursing homes to indicate the patient´s end of life treatment preferences. In addition, Governor Pataki signed the legislation on October 11, 2005 that permits a community pilot of the MOLST program in Monroe and Onondaga counties and allows for the use of the MOLST form in lieu of the New York State Non– hospital Do Not Resuscitate (DNR) form (DOH 3474). In all counties other than Monroe and Onondaga, the New York State Non–hospital Do Not Resuscitate (DNR) form is the required form to indicate DNR orders in non–hospital settings and should be attached to the MOLST form. In addition, as per current Department policy, Do Not Intubate (DNI) orders cannot be honored in pre–hospital settings.
Enclosed please find a copy of the MOLST form and the supplemental documentation forms for adults who lack capacity or meet "exceptional circumstances" and minors. Additional copies can be obtained by using the order form which is available online here.
Additional information about the MOLST form can be found here and here. Should you have questions, please refer them to molst@health..ny.gov .
Sincerely,
Martin J. Conroy
Director
Bureau of Hospital & Primary Care Services
Edward Wronski
Director
Bureau of Emergency Medical Services
Keith Servis
Division of Quality and Surveillance for Nursing Homes and ICFs/MR
