MOLST Form Updated Again
(June 3, 2025) The Department of Health (DOH) released a new update of the Medical Orders for Life-Sustaining Treatment (MOLST) form on June 2nd, along with a Dear Administrator Letter (DAL) describing the latest changes and proper use of the form. This update to the form comes on the heels of a revised MOLST released on May 1st.
The June 2nd update was issued in response to concerns raised by providers in relation to the May 1st form's orders concerning intubation and respiratory support and the instructions concerning review and renewal. The new version includes the following changes:
- Intubation Orders, Section C, has two changes:
- In the first check box, the word "may" is inserted in the following phrase: “Intubation and long-term mechanical ventilation, may include tracheostomy.”
- The second checkbox now reads: “A trial period of intubation and/or mechanical ventilation.” The prior version referred to intubation and long-term mechanical ventilation following the use of non-invasive ventilation.
- Review and Renewal, Section I, has five changes:
- The “decision-makers named in Section D” replaces the term “surrogate” for greater clarity.
- A statement was inserted to clarify that, even if the MOLST is not reviewed and renewed within 90 days, the last completed MOLST remains valid and must be followed.
- The attending practitioner is directed to void the form if the patient or other decision-maker named in Section D withdraws their consent to a decision in the MOLST or if the patient objects to the decision.
- The form clarifies that a health care agent or surrogate cannot change the decision to withhold/withdraw treatment that the patient had already made when they had capacity.
- The form specifies that if a health care agent or surrogate consented to "this MOLST," they are able to continue to make decisions to withhold/withdraw treatment based on the patient’s current health status.
The DAL notes that existing MOLST forms that have already been completed remain valid. In addition, these recent changes to the MOLST form are being incorporated into the electronic MOLST application (eMOLST).
The MOLST is generally for a patient with serious health conditions who:
- wants to avoid or receive any or all life-sustaining treatment;
- resides in a long-term care facility or requires long-term care services; and/or
- might die within the next year.
The MOLST form is just one way of documenting a patient’s treatment preferences concerning life-sustaining treatment. However, the MOLST form is the only authorized method of documenting both nonhospital Do Not Resuscitate (DNR) and nonhospital Do Not Intubate (DNI) orders. In addition to DNR and DNI orders, the form may be used to document medical orders related to other life-sustaining treatments such as hospitalization, dialysis, artificial nutrition and hydration, and antibiotics. It transitions with patients/residents across health care settings and must be followed by all health care providers.
The DAL recommends that providers involved with MOLST read the instructions and legal requirements checklists that are on the Department’s website here. When completing MOLST orders for a patient/resident with capacity, it is important to recognize that, under the revised MOLST's review and renewal instructions, if the patient/resident subsequently loses capacity, their decision-maker cannot modify the patient/resident's earlier decisions to refuse life-sustaining treatment. Thus, not only must the decision-maker adhere to the patient/resident's DNR decision, but the decision-maker is also prevented from changing the patient/resident's decision to refuse treatments such as intravenous (IV) fluids or antibiotics that might reverse an unexpected decline in their condition.
More information about the MOLST is available on the Department's website here.
Contact: Karen Lipson, klipson@leadingageny.org