Blank Massachusetts Molst Form

The Massachusetts MOLST (Medical Orders for Life-Sustaining Treatment) form is an essential document for patients and healthcare providers. Here are some key takeaways regarding its use and completion:

• Patient-Centered Conversations: The MOLST form should be filled out only after thorough discussions between the patient and the clinician. This ensures that the form accurately reflects the patient's wishes and goals of care.
• Signature Requirements: The form requires signatures from both the patient (or their representative) and the signing clinician. Without these signatures, the orders listed in the form may not be valid.
• Immediate Effectiveness: Once signed, the MOLST form is effective immediately. This means that healthcare providers must follow the orders specified in the form without delay.
• Visibility and Accessibility: To ensure that emergency medical personnel recognize the MOLST form, it should be printed on bright or fluorescent pink paper. This enhances visibility and increases the likelihood that the patient's wishes will be honored in emergency situations.

1. Incomplete Sections: Failing to fill out all required sections can lead to confusion and misinterpretation of the patient's wishes. Ensure Sections D and E are complete when filling out Sections A–C.

2. Not Signing the Form: The form must be signed by the patient or their representative. Without a signature, the form is not valid, and treatment preferences may not be honored.

3. Using Incorrect Paper: The MOLST form should be printed on bright or fluorescent pink paper for visibility. Using standard white paper can lead to it being overlooked in emergencies.

4. Failing to Discuss Goals of Care: The MOLST form should reflect a thorough discussion between the patient and clinician about treatment preferences. Skipping this step can result in orders that do not align with the patient's wishes.

5. Not Revoking When Necessary: If the patient's preferences change, it is crucial to revoke the existing MOLST form and create a new one. Failure to do so may lead to the continuation of outdated orders.

6. Ignoring Updates: The MOLST form may be updated over time. Always check the MOLST website for the most current version to ensure compliance with any changes.

7. Providing Copies Only: While photocopies of the signed MOLST form are valid, ensure that the original is always accessible. Keep it with the patient to guarantee that their wishes are honored in any medical setting.

When filling out the Massachusetts MOLST form, it's important to follow certain guidelines to ensure accuracy and compliance. Here’s a list of things you should and shouldn't do:

• Do ensure that all sections of the form are completed to avoid any treatment limitations.
• Do have a detailed conversation with the patient about their wishes and goals of care before signing.
• Do print the form on bright or fluorescent pink paper for visibility.
• Do provide photocopies or electronic versions of the signed form to relevant healthcare providers.
• Don't alter the MOLST form in any way; use the standardized version available online.
• Don't forget to include the date of signature; it is crucial for the form's validity.
• Don't skip the clinician's signature; it must be present for the form to be valid.
• Don't assume the form is valid without confirming that all necessary sections are filled out completely.

What is the Massachusetts MOLST form?

The Massachusetts MOLST (Medical Orders for Life-Sustaining Treatment) form is a standardized medical order form. It is approved by the Massachusetts Department of Public Health (DPH) and is intended for use by licensed healthcare professionals, including physicians, nurse practitioners, and physician assistants. The form outlines a patient's preferences regarding life-sustaining treatments.

Who can sign the MOLST form?

The MOLST form can be signed by the patient, a health care agent, a guardian, or a parent/guardian of a minor. The signer must reflect the patient's wishes and goals of care. If the patient lacks capacity, the health care agent or guardian can sign on their behalf.

When does the MOLST form take effect?

The MOLST form becomes effective immediately upon signature. Once signed, it provides clear medical orders that healthcare providers must follow regarding the patient's treatment preferences.

Are photocopies of the MOLST form valid?

Yes, photocopies, faxes, or electronic copies of properly signed MOLST forms are valid. It is important to ensure that the form is filled out completely and accurately to avoid any confusion regarding the patient's wishes.

What happens if a section of the MOLST form is not completed?

If any section of the MOLST form is not completed, there are no limitations on the treatment indicated in that section. This means that the healthcare provider may proceed with full treatment as necessary.

How should the MOLST form be printed?

The MOLST form should be printed on bright or fluorescent pink paper for maximum visibility. It is recommended to use Astrobrights® Pulsar Pink paper. The form should be printed double-sided on a single sheet of paper to ensure that both pages are included.

Can the MOLST form be revoked?

Yes, the patient or their representative can revoke the MOLST form at any time. They can also request and receive previously refused medically-indicated treatment. This ensures that the patient's current wishes are respected.

What should healthcare providers do with the MOLST form?

Healthcare providers must follow the orders listed in the MOLST form until they have the opportunity to review it with the patient. If any changes are needed, the old form should be voided, and a new one must be completed.

Where can I find more information about the MOLST form?

For more information about the Massachusetts MOLST form, visit the official MOLST website at www.molst-ma.org. This site provides resources for both patients and healthcare professionals regarding the use of the form.

Instructions on How to Fill Out Massachusetts Molst

Filling out the Massachusetts MOLST form is a crucial step in communicating a patient's medical preferences. This process involves careful consideration and discussion between the patient and their healthcare provider. Ensure that all sections are completed accurately to reflect the patient's wishes.

1. Begin by entering the patient's Name, Date of Birth, and Medical Record Number (if applicable) at the top of the form.
2. In Section A, mark one circle to indicate the patient's preference for Cardiopulmonary Resuscitation: either "Do Not Resuscitate" or "Attempt Resuscitation."
3. In Section B, indicate preferences for Ventilation by marking one circle for either "Do Not Intubate and Ventilate" or "Intubate and Ventilate." Then, mark one circle regarding Non-invasive Ventilation (e.g., CPAP).
4. In Section C, decide whether to Transfer to Hospital by marking one circle for "Do Not Transfer" or "Transfer to Hospital."
5. Move to Section D and mark the appropriate circle to indicate who is signing: the patient, health care agent, guardian, or parent/guardian of a minor.
6. Have the patient or their representative sign and date the form in the designated area of Section D.
7. In Section E, the signing clinician (physician, nurse practitioner, or physician assistant) must sign and date the form, confirming that it reflects their discussions with the signer in Section D.
8. Proceed to Section F, where you will indicate preferences for other medically-indicated treatments. Mark the appropriate circles for intubation, non-invasive ventilation, dialysis, artificial nutrition, and artificial hydration.
9. In Section G, repeat the process of indicating who is signing for this section and have them sign and date the form.
10. Finally, in Section H, the clinician must sign and date again, confirming the accuracy of this section.
11. Ensure all signatures and dates are legible. Review the form for completeness before finalizing.

Once completed, keep the MOLST form with the patient at all times. It is essential for healthcare providers to honor the preferences outlined in this document, ensuring that patient wishes are respected in medical situations.