Further Revisions to Medical Orders for Life Sustaining Treatment (MOLST)
The Situation Report | June 30, 2025
The New York State Department of Health (DOH) has recently updated the Dear Administrator Letter (DAL) dated May 1, 2025, pertaining to the Medical Orders for Life-Sustaining Treatment (MOLST) form (DOH-5003), and provides information regarding additional revisions that have been made to the MOLST. DOH was joined by the Office for People with Developmental Disabilities (OPWDD), Office of Mental Health (OMH), and the Justice Center for the Protection of People With Special Needs in updating this form. HCANYS has been a participant and strong supporter of the project.
Changes were made based on feedback from stakeholders in response to the version of the MOLST form released on May 1, 2025.
No changes have been made to the one-page Nonhospital Order Not to Resuscitate (DOH-3474).
Existing MOLST forms that have already been completed remain valid. The most recent changes to the MOLST form are being incorporated into the electronic MOLST application (eMOLST).
Future updates to the MOLST Checklists and Frequently Asked Questions (FAQs) will be forthcoming at a later date.
It is strongly recommended that staff involved with MOLST read the instructions and legal requirements checklists that are on the Department’s website here.
Changes to the MOLST form include the following:
- Section C, (page 1) has two changes:
o The first check box now reads, “Intubation and long-term mechanical ventilation, may include tracheostomy.”
o The second checkbox was replaced with the following language: “A trial period of intubation and/or mechanical ventilation.”
- Section I, (page 3), has five changes:
o The “decision-makers named in Section D” replace the term “surrogate” for greater clarity. o There is now a statement that clarifies that even if the MOLST is not reviewed and renewed within 90 days, the last completed MOLST remains valid and must be followed.
o A statement is included that directs the attending practitioner 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.
o This section now includes clarification 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.
o A statement has been added that 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.