MOLST is a DPH-approved Massachusetts medical order form that relays a seriously ill patient's choices about CPR, intubation and ventilation, non-invasive ventilation and hospital transfer, plus preferences on dialysis and artificial nutrition and hydration. A physician, nurse practitioner or physician assistant completes it after goals-of-care discussions with the patient, and it takes effect immediately upon signature.
The clinician fills in Sections A to C and F and signs Sections E and H. The patient, health care agent, guardian or parent of a minor signs Sections D and G; page 1 orders are valid only with D and E complete, page 2 only with G and H.
Download the current version from the source each time; forms change without notice.
Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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A licensed Massachusetts physician, nurse practitioner or physician assistant signs Sections E and H, confirming the form reflects their discussion with the patient or representative. A health care agent can sign Sections D and G when a clinician has verified in writing that the patient lacks capacity; a guardian only as far as state law permits.
Yes. The Executive Office of Aging & Independence posts sample MOLST forms and consumer FAQs in Spanish, Portuguese, Vietnamese, Chinese, Haitian Creole, Russian, Khmer and Cape Verdean Creole alongside the English form, the instructions and the MOLST Clinician Checklist.
Yes. The state says an existing MOLST remains valid and will be honored after the spring 2027 transition to the National POLST model. Until the transition, providers should keep documenting patients' wishes on the MOLST form, and former POLST test sites continue using their paper POLST forms.