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South Dakota MOST Form: Scope of Treatment Orders

Created by South Dakota Senate Bill 118, signed March 27, 2019, this medical order records CPR, medical intervention and artificial nutrition and hydration orders for patients diagnosed with a terminal illness. It records the terminal diagnosis and goals of care, and it complements rather than replaces an advance directive. Clinicians complete it after an informed consent discussion with the patient or authorized representative.

Who completes it

A physician, nurse practitioner or physician assistant completes the orders and Section D, and an MD, DO, NP or PA must sign and date it. The patient or authorized representative must also sign and date it.

Submitting and payment

How to submit it
Nothing is filed; the patient keeps the current form, and photocopies and faxes of signed and dated forms are legal and valid, though the original is strongly encouraged.

Good to know

  • Nutrition by tube can be withheld only if the provider answers yes to at least one of four questions in Section C, such as being more burdensome than beneficial.
  • A blank section is a directive to use all necessary and appropriate medical interventions for that section.
  • If the MOST conflicts with an earlier, unrevoked durable power of attorney or living will, providers follow the MOST.
  • To void it, draw a line through Sections A to D, write VOID, sign and date, and keep the old form in the record.

Get the official form

Download the current version from the source each time; forms change without notice.

South Dakota Medical Orders for Scope of Treatment (MOST)

Official pagePDFVersión en español

Fill it with Vero

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.

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How this list is checked

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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Frequently asked questions

Is the South Dakota MOST form available in Spanish?

Yes. The South Dakota Association of Healthcare Organizations posts a Spanish version alongside the English form. SDAHO also offers a MOST FAQ, a policy template for facilities, a patient brochure and recorded webinars from 2019 and 2023, along with the related South Dakota statutes.

How is a South Dakota MOST revoked?

A patient can revoke it by destroying or defacing it, by a signed and dated written revocation, or orally in front of a witness aged 18 or older who signs and dates a confirmation. An authorized representative may revoke only a MOST they executed, in writing. Providers record the date and time they learn of a revocation.