This physician order sheet, recognized under N.C.G.S. 90-21.17, records the patient's choices on CPR, scope of medical intervention, antibiotics, and medically administered fluids and nutrition. It is honored across settings and by EMS. Clinicians complete it with patients or their representatives as part of advance care planning, and the original form travels with the patient.
A health care professional prepares it with the patient or representative, and a licensed physician, PA or nurse practitioner must sign and date it. The patient or representative signs too, or a signed copy is kept on file and noted in the signature field.
Download the current version from the source each time; forms change without notice.
Medical Orders for Scope of Treatment (MOST)
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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Only physicians' offices and licensed hospitals or health care facilities may download and print it from the NC Office of EMS, which no longer mails forms. It must be printed on Astrobrights Pulsar Pink paper, and unauthorized downloading may lead to action by the Office of EMS.
Section E lists who may discuss and agree to the orders: the patient, a parent or guardian of a minor, a health care agent, a legal guardian, an attorney-in-fact, a spouse, a majority of reasonably available parents and adult children, a majority of adult siblings, or an individual with an established relationship acting in good faith.