A Step-by-Step Guide to Complete The 2024 Maryland MOLST Form

The Maryland MOLST form is among the most essential documents to include in your healthcare toolbox.

At some point in our lives, many of us may face a medical crisis that leaves us unable to make medical decisions.

Click to Download The 2024 Maryland MOLST form

Maryland MOLST Form

Why All Marylanders Should Complete A Maryland MOLST Form 

We may rely on our loved ones (or healthcare providers) to make critical healthcare decisions for us during medical emergencies.

What would happen if you were in a car accident and couldn’t speak for yourself? How would the medical professionals treating you know what your wishes are?

A MOLST from is the solution to this problem!

The Maryland MOLST (Medical Orders for Life-Sustaining Treatment) is a standardized legal medical order form that documents and notates your preferences for life-sustaining medical treatments.

Healthcare professionals use it to communicate and respect your medical treatment choices.

A licensed Maryland physician, nurse practitioner, or physician assistant is eligible to legally sign and date your MOLST order form; otherwise, your MOLST order is considered invalid.

There are no legal requirements to complete a MOLST form.

What information is listed on the MOLST form MD? 

The Maryland MOLST form Md includes seven sections.

Section 1: Your personal information

• Full name
• Date of Birth
• Gender

Section 2: Your preference for CPR in the event of cardiac or respiratory arrest

• Attempt CRP;
• Do not attempt CPR (DNR or Allow Natural Death).

Section 3: Your preference for medical intervention, such as hospitalization or intensive care

• Full treatment;
• Limited Interventions;
• Comfort care measures only.

Section 4: Your preference for using antibiotics

• Use antibiotics, if indicated;
• Do not use antibiotics;
• Use antibiotics for comfort only.

Section 5: Your preference for using tube feeding (Artificially Administered Fluids and Nutrition)

• Long-term use, if indicated;
• Defined trial period;
• Symptom management only;
• Do not use.

Section 6: Additional Maryland Medical Orders

In this section, list any additional Maryland medical orders or other life-sustaining treatments related to your care.

Section 7: Signatures & Documentation

• A doctor, nurse practitioner, or physician assistant signs the order;
• You sign the order;
• A healthcare agent or surrogate decision-maker can sign the order;
• The section also includes contact information for your healthcare agent or surrogate decision-maker, if applicable.

Why Should I Complete a Maryland MOLST Form?

A patient’s wishes are communicated during a healthcare emergency

The MOLST form clearly and concisely notates your preferences for life-sustaining treatment.

This helps to ensure that your healthcare providers, emergency medical services systems, family members, and caregivers understand your medical treatment choices and can honor them during a medical emergency.

The MOLST form is legally recognized in Maryland.

Your healthcare providers must follow the orders outlined in the form, ensuring your treatment wishes are respected.

Completing the order facilitates informed decision-making during a healthcare emergency.

Completing a MOLST form encourages you to discuss your values, goals, and preferences for medical treatment and end-of-life care with your healthcare provider, family members, and loved ones.

This helps everyone involved in your care make informed decisions that align with your wishes.

It helps you avoid unwanted life-sustaining treatment(s) during a medical emergency

By clearly stating your preferences for life-sustaining treatments, you can help prevent unwanted or overly aggressive medical interventions that may not align with your goals or values.

The MOLST form guides others during medical emergencies

Maryland healthcare providers may need to make quick decisions regarding your medical treatment in emergencies.

A MOLST form readily available ensures that your preferences are known and followed – even if you cannot communicate them yourself.

Supports continuity of care

As you move between different healthcare settings (e.g., hospitals, skilled nursing homes, or hospices), the MOLST form is a consistent document that communicates your preferences for life-sustaining treatments and reflects a patient’s wishes.

This helps maintain continuity of care and ensures your treatment preferences are respected across different care settings.

13 Simple Steps to Completing a Maryland MOLST form

Step 1: Download the latest version of the Maryland MOLST form.

Maryland MOLST Form

Step 2: Review the instructions on the form carefully.

Read the instructions carefully to understand the form’s purpose and what information you should include.

Step 3: Input your personal information at the top of the form, including:

• Type or handwrite your last name, first name, and middle initial;
• Enter your date of birth;
• And enter your gender.

Step 4: Complete Section One | Cardiopulmonary Resuscitation (CPR)

You have two options to choose from regarding CPR during a medical emergency:

1) Attempt CPR, including artificial ventilation and intubation;

2) Do NOT attempt CPR (Do Not Resuscitate and Allow Natural Death)

Option A: Comprehensive efforts to prevent arrest

Before the arrest, you authorize a healthcare professional to administer all medications needed to stabilize you – but you do NOT want CPR.

Option A-1: Intubate

Comprehensive efforts may include intubation and artificial ventilation.

Option A-2: Do NOT Intubate (DNI)

Comprehensive efforts may include limited ventilatory support by CPAP or BiPA – but do not intubate.

 

 

Option B: No CPR, but you request Palliative and Supportive Care.

Before the arrest, provide passive oxygen for comfort, control any external bleeding, and provide medications for pain relief, as needed – but no other medications.

You do not want to be intubated, and you do not want to use a CPAP or BiPAP. If the cardiac and pulmonary arrest occurs, you do not wish to have resuscitation attempted (No CPR).

You wish for your death to occur naturally.

Step 5: Your healthcare practitioner completes this section

• Your practitioner’s signature and printed name;
• Your practitioner’s Maryland medical license number;
• Your practitioner’s phone number;
• And your practitioner will date the form.

Remember: Only a Maryland doctor, nurse practitioner, or physician assistant can sign your MOLST form. An order is considered invalid if your healthcare clinician does not sign it.

 

Step 6: Complete Section Two | Artificial Ventilation

• Emergency personnel may use intubation and artificial ventilation indefinitely if medically indicated;
• EMS may use intubation and artificial ventilation as a limited therapeutic trial. (Please indicate your preferred time limit);
• You may use only a CPAP or BiPAP for artificial ventilation as medically indicated. (Please indicate your preferred time limit);
• You do not want artificial ventilation (no intubation, CPAP, or BiPAP).

Step 7: Complete Section Three | Blood Transfusion

You have two distinct options from which to choose:

1. A healthcare practitioner may give you any blood product (whole blood, packed red blood cells, plasma, or platelets) that is medically indicated;
2. You do not want any blood products given.

Step 8: Complete Section Four | Hospital Transfer

• You check off this section if you want to be transported to a hospital for any medical situation requiring hospital-level care; in other words, you want to go to the hospital;
• You only want to be transferred to a hospital for severe pain or severe symptoms that cannot be controlled otherwise;
• You do not want to be transferred to a hospital; instead, you want emergency personnel to treat you with options available outside of a hospital.

 

 

Step 9: Complete Section Five | Medical Workup

• You want a healthcare professional to perform any medical tests, as indicated, to diagnose and treat a medical condition;
• You only want EMS to perform limited medical tests necessary for symptomatic treatment or comfort;
• You do not want any medical tests for diagnosis or treatment.

Step 10: Complete Section Six | Antibiotics

• You request the use of antibiotics (oral, intravenous, or intramuscular) as medically indicated;
• EMS may use oral antibiotics only when medically indicated – but you do not want intravenous or intramuscular antibiotics;
• Administer oral antibiotics only when indicated for symptom relief or comfort;
• You do not want to be treated with antibiotics.

Step 11: Complete Section Seven | Artificially Administered Fluids & Nutrition

• You authorize EMS to give you artificially administered fluids and nutrition, even indefinitely, if medically indicated;
• You authorize EMS to artificially administer fluids and nutrition as a trial if medically indicated. (Please indicate your preferred time limit);
• You authorize artificial hydration as a therapeutic trial but do not want artificially administered nutrition. (Please indicate your preferred time limit);
• You do not want artificially administered fluids or nutrition.

Step 12: Complete Section Eight | Dialysis

• You authorize a healthcare practitioner to give you chronic dialysis for end-stage kidney disease if medically indicated;
• You want to receive dialysis only for a limited period. (Please indicate your preferred time limit.);
• You do not want acute or chronic dialysis

Step 13: Complete Section Nine | Other Orders

Use this section to document any other life-sustaining treatments.

Maryland MOLST Form Frequently Asked Questions

When does a MOLST form take effect?

Medical orders for life-sustaining treatment must be completed for newly admitted patients during the admission process in all Maryland assisted living programs, home health agencies, hospices, kidney dialysis centers, and nursing homes.

Please note that all Maryland hospitals must complete MOLST forms for all patients before they are discharged or transferred to another hospital, assisted living community, hospice, kidney dialysis center, home health agency, or nursing home.

Once completed, the order becomes part of the patient’s medical record.

Why are there numerous treatment choices included within the form? Do they all have to be completed?

The MOLST form makes the decision-making process available and convenient, reminding patients and healthcare providers of all the available treatment options.

It matches the potential range of orders to existing documentation of the patient’s treatment preferences.

There is no requirement to make any treatment choices or a certain number of options.

The form is to indicate only treatment options selected by the patient (or an authorized decision maker in case of the patient’s incapacity).

Does the MOLST form cover everything patients and practitioners need to know about making choices and completing the form?

The form is a means for documenting specific orders related to life-sustaining medical treatments.

However, the form itself is not the same as making decisions and choosing treatment options that are ultimately ordered on the form.

Patients and healthcare practitioners should use some of the many available resources and references to help them consider treatment options; they should discuss, make, and document these decisions.

Is adherence to MOLST orders mandatory in all settings?

When an order is written in one setting, it remains in effect until changed in that and subsequent settings.

A MOLST form is a portable and enduring medical order form.

Until they are updated, the orders must be honored by EMS medics and healthcare personnel in all healthcare settings – even if the healthcare practitioner who signed the orders for life-sustaining treatment is not on staff at a facility.

Can I update my MOLST form at any time?

You can update your form at any time or otherwise revise or rescind it at any future time, as long as the decision-making behind such changes is consistent with applicable laws and regulations.

For example, another individual cannot simply rescind or contradict orders based on decisions made by a capable person who subsequently loses their decision-making capacity unless that person specifically authorized them to do so in a legally valid document (e.g., an advance directive or a durable power of attorney).

Suppose the situation changes significantly for someone who made choices turned into MOLST orders.

In that case, it may be appropriate to reconsider the relevance of previous choices in light of the current situation – unless that person or patient’s wishes or previous valid care instructions restrict doing so, or there are other determinations such as the medical ineffectiveness of specific treatments.

Can I decline some of the treatment options listed on the MOLST form?

Suppose you or your chosen decision-maker declines to consider some of the options listed on the form for whatever reason.

In that case, the healthcare facility should document your decision and explain the consequences of making no decision – to you or your decision-maker, whatever the case.

IMPORTANT: If there are no limitations on care, except as otherwise provided by law, cardiopulmonary resuscitation will be attempted, and other treatments may be given.

If a choice regarding (CPR) is not made, resuscitation will be attempted using all available treatment options (e.g., CPR on the MOLST form).

Several factors influence whether and to what extent treatment will be given.

For example, under the Health Care Decisions Act, a healthcare practitioner is not obliged to recommend or render treatments that they consider medically ineffective.

However, the practitioner must follow a specific process to implement such decisions.

Is the MOLST form an advance directive?

No, the Maryland MOLST form is not an advance directive but a medical order.

MOLST orders are effective immediately when signed, whereas treatment choices in advance directives may not apply until later.

The idea behind providing treatment options in an advance directive is to allow you to make choices that you may want to apply in the future while having the capacity to do so in case you subsequently lose the ability to do so.

The Senior Soup recommends that you speak to an estate planning attorney for questions about advance directives.

Sarah Broder, an estate planning attorney with the Stein Sperling law firm in Rockville, Maryland, was featured on The Senior Soup Podcast in October 2022 and discussed estate planning, advanced directives, and other long-term care planning responsibilities.

What is the difference between a Maryland MOLST form and an Advance Directive?

A MOLST form contains medical orders related to your current medical condition.

Maryland advance directives provide medical guidance to healthcare practitioners – but treatment decisions must be based on medical orders.

A MOLST form is needed to implement those orders, even if you have an advance directive.

In addition, your MOLST form can move with you among settings along with your other active medical order forms.

If you have both an advance directive and a MOLST order form, there may be situations where the two documents conflict. In such cases, if an order on the MOLST form is based on your currently obtained informed consent, there is no need to consult the advance directive.

Suppose an order was not based on your currently obtained informed consent.

In that case, the current orders should be consistent with the instructions in a valid advance directive unless updated by a substitute decision-maker who is authorized in an advance directive to do so.

What happens if I don’t have a Maryland MOLST or an EMS/DNR form when emergency medical services providers arrive?

If you cannot communicate your healthcare wishes to emergency personnel without a valid MOLST form or EMS/DNR order, EMS will perform the full scope of interventions permissible under the Maryland EMS Medical Protocols, including, if necessary, aggressive, life-saving cardiopulmonary resuscitation.

What constitutes a valid Do Not Resuscitate (DNR) order for Maryland emergency medical services?

• A Maryland MOLST form (original, copy, or fax);
• A Maryland MOLST vinyl bracelet insert;
• A Maryland EMS DNR order form (original, copy, or fax);
• A Maryland EMS DNR vinyl bracelet insert;
• A Medic Alert bracelet or necklace specifying DNR;
• An out-of-state form via reciprocity (original, copy, or fax);
• An oral order from a physician, nurse practitioner, or physician assistant;
• A verbal order from a medical command physician.

What does NOT constitute a valid DNR Order for Maryland emergency medical services?

None of the following provide valid DNR orders:

• An advance directive;
• Notes in your medical records;
• A facility-specific DNR order;
• Colored bracelets that are not part of the MOLST order form or from Medic Alert;
• Orders that are written on a practitioner’s prescription pad;
• DNR stickers;
• Oral requests from family or caregivers;
• A healthcare clinician who is not at the scene with the patient makes an oral request for DNR.

Where should I keep my MOLST forms?

The completed form should be kept in a secure but readily accessible and visible location.

You may keep copies by your bedside, above your bed, behind a bedroom door, or on your refrigerator door, which is readily accessible during an emergency.

Will EMS honor my life-sustaining treatment form from another state if I don’t live in Maryland? 

Yes.

Maryland EMS providers are authorized to follow out-of-state EMS/DNR orders.

However, suppose you’re staying in Maryland for any length of time. In that case, you may wish to get a Maryland order signed to address any additional life-sustaining treatment options that the MOLST contains.

When must a provider accept and update an existing MOLST form?

When a patient is admitted to a hospital, nursing home, assisted living program, home health agency, hospice, or kidney dialysis center with a completed MOLST form, the orders on it should be reviewed during admission.

The admissions process is when a physician or other authorized health care practitioner evaluates the patient and writes admission orders.

Suppose the form is inaccurate or the patient or authorized decision maker wishes to authorize a change in the orders within the document.

In that case, the healthcare provider will revise the form by completing a new form.

May a surrogate decision maker authorize a DNR order when the individual is not in a qualifying condition such as a terminal condition, end-stage condition, or a persistent vegetative state?

If two physicians certify that you are in a terminal condition or an end-stage condition at the time of a cardiac or pulmonary arrest, a DNR order may be written at this time.

The physicians must certify that if you suffer a cardiac arrest, you will be in a terminal or end-stage condition – even if CPR would prevent death from the initial cardiac arrest.

What does “Palliative Care” mean in section one of the form? 

When “No CPR, Option B, Palliative and Supportive Care” has been marked on the MOLST form, EMS will not treat reversible conditions pending an imminent arrest.

However, EMS will only provide pain management and basic first aid, including bleeding control and splinting.

Option B is not meant for someone with a non-terminal and reversible disease process condition.

For such an individual for whom a DNR order is desired, the MOLST form should be marked as either “No CPR, Option A-1, with Intubate” or “No CPR Option A-2, Do Not Intubate (DNI).”

By selecting “No CPR A-1” or “No CPR A-2,” EMS personnel or a healthcare provider can treat any reversible conditions (e.g., low blood sugar, congestive heart failure, asthma/COPD).

Can I store my MOLST form on my cell phone or another electronic device for EMS to review?

Yes.

You can store your MOLST form on your cell phone.

Please note that electronic copies of the form are valid, recognizing that not all ambulances/EMS providers are equipped to receive, store, or transmit electronic copies – and they are not required to do so.

If you have only an electronic copy of the form, an EMS provider should document it and honor it.

Can a MOLST form DNR order be suspended during surgery?

Yes.

A MOLST form’s DNR order may be suspended during surgery.

Maryland Resources

Maryland State Government: 

• Maryland Office of the AttorneyGeneral’ss Advice Letter
• Maryland Office of the AttorneyGeneral’ss Opinion – Applying the Health Care Decision Act to “Do Not Resuscitate” Orders

Additional Resources:

• Advance Directives 
• Electronic Advance Directives in Maryland
• National Hospice and Palliative Care Organization
• Hospice and Palliative Care Network of Maryland 
• Maryland Institute for Emergency Medical Services Systems
• Maryland Medical Documents Resource Guide