The MOLST form is a set of medical orders for patients with advanced illness who might die within 1-2 years; require long-term care services; or wish to avoid and/or receive specific life-sustaining treatments now. Best practice is to offer MOLST. Completion of MOLST is voluntary. The physician, nurse practitioner (NP) or physician assistant (PA), beginning June 17, 2020, reviews the patient’s current health status, prognosis, the patient’s goals for care, risks and benefits of each life-sustaining treatment with the patient if they have capacity, or the health care agent or surrogate if the patient lacks capacity. All ethical and legal requirements must be followed, including special procedures when a patient has an intellectual or developmental disability and lacks capacity. If the patient is unable to make medical decisions, the medical orders should reflect patient wishes, as best understood by the health care agent or surrogate and based on the patient’s values, beliefs and goals.
MOLST became a New York State Department of Health (DOH) form, at the same time Family Health Care Decisions Act (FHCDA) became effective on June 1, 2010. DOH decided to have the DOH-5003 (6/10) MOLST written in plain language to ensure the physicians, NPs, PAs, , other clinicians, patients, health care agents, surrogates and all who are involved in the process of completing the MOLST understand what MOLST represents. In addition, using plain language allows for appropriate translation into other languages for educational purposes only and to prepare the medical decision maker for the MOLST discussion. A Spanish translation of the MOLST is available for educational purposes only. The Spanish MOLST may not be completed or signed by the physician, NP, or PA, but it can be used to educate Spanish-speaking patients and families about the MOLST process and form.
The MOLST form was revised to comply with changes in NYS Public Health Law (PHL) that changes the authority of nurse practitioners and accountability for proper completion of and signing the MOLST form. Please Note: The changes in PHL do not amend the Surrogate Court Procedures Act (SCPA) 1750-b, which relates to individuals with developmental disabilities who lack the capacity to make their own health care decisions and do not have a health care proxy.
The revised MOLST form was posted on the DOH web page on December 31, 2018. eMOLST was updated; when eMOLST is queried for the most recent eMOLST form and copy of the MOLST discussion, all eMOLST forms created after January 1, 2019 reflect the revised DOH-5003 12/18 MOLST form.
As a result of revised PHL, the authority of physician assistants, as of June 17, 2020 and accountability for proper completion of and signing the MOLST form. Given the COVID-19 pandemic, it is unlikely that a revised MOLST form will be available.
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The MOLST Update is a Newsletter dedicated to providing up-to-date information on advance care planning, MOLST and eMOLST.