Massachusetts Medical Orders for Life-Sustaining Treatment
This document provides the Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST). It includes sections on resuscitation, ventilation, patient preferences, and hospital transfer. The form is designed to be used by healthcare providers to discuss and record patients' treatment preferences.
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How do I fill this out?
To fill out this form, you need to have a detailed conversation with your clinician about your treatment preferences. Ensure that each section is completed accurately to reflect your wishes. The form is valid only when it is signed by both the patient and the clinician.
How to fill out the Massachusetts Medical Orders for Life-Sustaining Treatment?
1
Have a detailed discussion with your clinician about your treatment preferences.
2
Complete Sections A-C if Sections D and E are complete.
3
Ensure Sections F, G, and H are also accurately filled if applicable.
4
Sign the form along with your clinician to make it valid.
5
Always carry a copy of the completed form with you.
Who needs the Massachusetts Medical Orders for Life-Sustaining Treatment?
1
Patients with serious health conditions need this form to document their treatment preferences.
2
Health care agents require this form to make informed decisions on behalf of the patient.
3
Guardians need the form to ensure the patient's wishes are respected concerning life-sustaining treatments.
4
Physicians, nurse practitioners, and physician assistants use this form for clear medical orders.
5
Emergency medical personnel need this form to understand and honor the patient’s treatment preferences during emergencies.
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With PrintFriendly, you can easily edit your MOLST form using our intuitive PDF editor. Add, delete, or modify text fields to ensure all information is accurate. Save your changes and print or download the updated form.
1
Open the MOLST form in PrintFriendly’s PDF editor.
2
Click on the text fields to add or modify information.
3
Use the tools to delete any unnecessary areas.
4
Make sure all sections are filled out accurately.
5
Save and print or download the edited form.
What are the instructions for submitting this form?
Submit the completed MOLST form by providing a copy to your primary healthcare provider and ensuring that it is included in your medical records. You should also keep a copy at home and carry one with you at all times. For electronic submission, check with your healthcare institution if they accept digital copies via email or online submission forms. Always provide physical copies printed on bright pink paper as recommended. Advice: Validate the form with proper signatures and review periodically for any changes in treatment preferences.
What is the purpose of this form?
The purpose of the Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST) form is to record and communicate patients' preferences for life-sustaining medical treatments. This form is especially important for patients with serious health conditions who wish to have a say in their treatment options should they become unable to communicate their decisions in the future. The MOLST form serves as a legal document that healthcare providers and emergency medical personnel can refer to when making treatment decisions. By clearly outlining the patient's wishes, the MOLST form helps to ensure that the medical care provided aligns with the patient's goals and preferences. It also provides peace of mind to patients and their families, knowing that their treatment choices will be respected and followed by healthcare providers.
Tell me about this form and its components and fields line-by-line.
- 1. Patient's Name: The full name of the patient for identification purposes.
- 2. Date of Birth: The patient's birth date to ensure correct identification and medical record matching.
- 3. Medical Record Number: The unique identifier for the patient's medical records, if applicable.
- 4. Cardiopulmonary Resuscitation (Section A): Patient's preferences for resuscitation in the event of cardiac or respiratory arrest.
- 5. Ventilation (Section B): Patient's preferences for intubation and ventilation in respiratory distress situations.
- 6. Patient and Representative Signature (Section D): Signatures confirming the patient's wishes and the representative's agreement with the recorded preferences.
- 7. Clinician Signature (Section E): Signature of a physician, nurse practitioner, or physician assistant verifying the discussion and treatment preferences.
- 8. Other Treatments (Section F): Patient's preferences for other medically-indicated treatments like dialysis, artificial nutrition, and hydration.
- 9. Additional Instructions (Section H): Additional guidance to healthcare professionals about following the patient's preferences and when to review the form.
- 10. Expiration Information: Any specified expiration date for the document, indicating when it should be reviewed or updated.
What happens if I fail to submit this form?
Failing to submit the MOLST form means that healthcare providers may not have clear instructions on the patient's treatment preferences. This could result in receiving full treatment regardless of the patient's wishes.
- Ambiguity in Treatment Decisions: Without the MOLST form, there may be confusion or disagreements about the preferred course of treatment.
- Unwanted Medical Interventions: A lack of documented preferences may lead to the patient receiving life-sustaining treatments they may not have wanted.
How do I know when to use this form?
- 1. Serious Health Condition: Patients with serious or terminal health conditions use this form to document their treatment preferences.
- 2. Treatment Preferences: Individuals who wish to specify their preferences for resuscitation, ventilation, and other treatments.
- 3. Healthcare Communication: To ensure that healthcare providers and emergency personnel understand and follow your medical treatment wishes.
- 4. Legal Documentation: As a legally recognized document to communicate your treatment preferences and provide clear instructions to healthcare agents and guardians.
- 5. Healthcare Proxy: For patients who have appointed a healthcare proxy, to ensure that their treatment preferences are honored.
Frequently Asked Question
What is the MOLST form?
The MOLST form is a medical order form in Massachusetts for documenting a patient's treatment preferences regarding life-sustaining treatments.
Who needs to fill out the MOLST form?
Patients with serious health conditions, their health care agents, guardians, and healthcare providers should use the MOLST form.
How do I fill out the MOLST form?
To fill out the MOLST form, have a detailed discussion with your clinician, complete all sections, and ensure it is signed by both you and your clinician.
Can I edit the MOLST form on PrintFriendly?
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Use the PDF editor in PrintFriendly to add your digital signature to the MOLST form, then save and print or download the signed document.
Can I share the MOLST form from PrintFriendly?
Yes, after completing and signing the form, you can share it via email or generate a sharable link directly from PrintFriendly.
What happens if I don't submit the MOLST form?
Without a submitted MOLST form, there may be ambiguity in decisions regarding life-sustaining treatments, which could lead to receiving full treatment regardless of your preferences.
What sections are mandatory in the MOLST form?
Sections D and E must be completed for Sections A-C to be valid, and Sections G and H must be completed for Section F to be valid.
How can I update my MOLST form?
To update your MOLST form, void the old form by writing VOID across it and complete a new form with the updated information.
Is the MOLST form recognized statewide in Massachusetts?
Yes, EMTs and healthcare providers in Massachusetts are trained to recognize and honor the standardized MOLST form.
