Patient and Caregiver Information for after signing MOLST
IN A MEDICAL EMERGENCY
INFORMATION FOR PATIENTS WITH MOLST FORMS
- Keep your MOLST form in a place where it is easy for others to locate.
- Carry your MOLST form (or a copy) when you travel outside of your home.
- Inform your family, health care agent and caregivers about your MOLST form.
- Discuss your treatment decisions and goals with your loved ones.
- Keep a list of anyone who has a copy of your MOLST.
- To void the MOLST form, write “VOID” across both sides.
- If the MOLST is voided, tell everyone who has a copy to destroy their copy.
- Ask your clinician to fill out a new MOLST form with you if you want one.
INFORMATION FOR FAMILY MEMBERS AND CAREGIVERS
- The MOLST form is filled out and signed by a clinician after discussions with the patient.*
- The MOLST form is used voluntarily by patients* to communicate treatment decisions.
- The MOLST form reflects the decisions the patient* expressed to the signing clinician.
- The MOLST form should travel with the patient at all times.
- The MOLST form is to be honored by licensed health professionals in any setting.
- Patients* can change their mind and choose to receive medically-indicated treatment, no matter what the MOLST says.
* (Or the patient's health care agent, if the patient lacks capacity)