Medical Orders for Life-Sustaining Treatment (MOLST)

Honoring patient preferences is a critical element in providing quality end-of-life care. To help physicians and other health care providers discuss and convey a patient's wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatment, the DOH as approved form (DOH-5003), Medical Orders for Life-Sustaining Treatment (MOLST), which can be used statewide. MOLST is intended for patients with serious health conditions who:

  • Want to avoid or receive any or all life-sustaining treatment;
  • Reside in a long-term care facility or require long-term care services; and/or
  • Might die within the next year.

Download (DOH-5003), Medical Orders for Life-Sustaining Treatment (MOLST)
The MOLST form can be printed on any color paper

The MOLST must be completed based on the patient’s current medical condition, values, and wishes. Completion of the MOLST begins with a conversation or a series of conversations between the patient, the patient's health care agent or surrogate, if appropriate, and a qualified, trained health care professional. These conversations should include defining the patient's goals for care, reviewing possible treatment options, and ensuring shared, informed medical decision-making. The conversations should be documented in the medical record.

Although the conversation(s) about goals and treatment options may be initiated by any qualified and trained health care professional, a licensed physician, nurse practitioner, or physician assistant must always, at a minimum: (i) confer with the patient and/or the patient's health care agent or surrogate about the patient's diagnosis, prognosis, goals for care, treatment preferences, and consent by the appropriate decision-maker; and (ii) sign the orders derived from that discussion.

The MOLST form is one way of documenting a patient's treatment preferences concerning life-sustaining treatment – providers may choose to use other forms. However, under State law, the MOLST form is the only authorized form in New York State for documenting both a nonhospital do not resuscitate (DNR) and a nonhospital do not intubate (DNI) order. In addition, the form is beneficial to patients and providers as it provides specific medical orders and is recognized and used in a variety of health care settings.

In hospitals, hospice and nursing homes, the form may be used to issue any orders concerning life-sustaining treatment. In the community, the form may be used to issue nonhospital DNR and DNI orders, and in certain circumstances, orders concerning other life-sustaining treatment. The signed MOLST form should be transported with patients as they travel to different health care settings. The medical orders on the form need not be re-issued by the patient's new health care provider, but should be reviewed and may be revised by a physician, nurse practitioner, or physician assistant, when the patient transitions to a different setting and when the patient's preferences and/or medical conditions change.

In addition to the MOLST form, the Department has developed legal requirements checklists. The checklists are intended to assist providers in satisfying the legal requirements associated with decisions concerning life-sustaining treatment for patients. The Office for People With Development Disabilities (OPWDD) has created an additional checklist for any patient with an intellectual or developmental disability who lacks medical decision-making capacity and does not have a health care proxy. The Department of Health’s checklists are guidance documents, and the use of these checklists is strongly encouraged but not mandatory. Providers that do not use the provided checklists must use an alternative method for ensuring that they adhere strictly to all legal requirements for completing the form, including requirements related to securing informed consent to the medical orders from the proper person, making the clinical judgments necessary to support orders withholding or withdrawing life sustaining treatment and, where applicable, securing ethics committee approval and witnesses to the consent.

How to complete a MOLST

MOLST Dear Administrator Letter

General Instructions for the MOLST, Legal Requirements Checklists or Adult Patients, and Glossary

MOLST legal requirements checklists and general instructions for adult patients are:

MOLST legal requirements checklist for minor patients is:

Frequently Asked Questions regarding MOLST:

A Note Regarding Use of MOLST for Persons With Mental Illness or Developmental Disabilities Who Lack Decision-Making Capacity:

The MOLST form has been approved by the Office of Mental Health (OMH) and OPWDD for use as a nonhospital DNR/DNI form for persons with developmental disabilities or persons with mental illness, including persons who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act. OPWDD has created its own checklist for patients of any age with developmental disabilities who lack medical decision-making capacity and who do not have a health care proxy, which must always be attached to the MOLST form and can be found here OPWDD checklist.