MOLST/POLST ACP Forms

A POLST form is generally only appropriate for people who are in the final year of life, or suffering from an advanced stage terminal illness or an illness from which they are not expected to recover. It is complementary to an Advance Directive. (To find your state’s advance directive form, use our resource State-by-State Advance Directive Forms.)

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.