Get New York State Department Of Health, Bureau Of Ems Policy Statement 08-07 Re: Medical Orders For

This guide provides comprehensive instructions for completing the New York State Department of Health, Bureau of EMS Policy Statement 08-07, which pertains to Medical Orders for Life Sustaining Treatment (MOLST). It is designed to assist individuals in accurately filling out the form online, ensuring compliance with New York State's regulations regarding end-of-life care.

Follow the steps to successfully complete the MOLST form online.

1. Click ‘Get Form’ button to access the MOLST form and open it in your preferred editor.
2. Enter the patient’s full name, including Last Name, First Name, and Middle Initial, along with their address, city/state/zip code, date of birth, gender, and unique patient identifier (last four digits of SSN).
3. Review Section A titled 'Resuscitation Instructions.' Indicate the patient's preferences regarding resuscitation by checking one box: either 'Do Not Resuscitate (DNR)' or 'Full Cardiopulmonary Resuscitation (CPR)'. Ensure this section is completed accurately.
4. If the patient has decision-making capacity, they must sign in the consent area. For patients without capacity, a health care agent or surrogate decision-maker must complete the appropriate sections.
5. Complete Section C, which requires the physician's authorization. The physician must sign and print their name and provide their license number and contact information.
6. Proceed to Section E for orders on life-sustaining treatment and hospitalization. Consult with the patient or decision-maker to outline preferences for additional treatments and ensure the physician provides the necessary signature.
7. Fill in any additional instructions or components in the form as applicable to ensure all necessary information is documented. Review for completeness.
8. Once all sections are completed, save your changes, and prepare to download, print, or share the form as required.

Take the next step by filling out your Medical Orders for Life Sustaining Treatment form online today.