MOLST/POLST is for people with serious illness — it is NOT a substitute for an advance directive for healthy adults

Review the form with your physician whenever your health status changes significantly

The form must be on the official state-issued colored paper (usually bright pink or green) to be honored by EMS

Advance PlanningmoderateDoctor signature required

MOLST (Medical Orders for Life-Sustaining Treatment)

MOLST · State Health Departments (e.g., New York)

New York's version of POLST. The only authorized form in NY for documenting non-hospital DNR and DNI orders. Must be completed by a physician in consultation with the patient or surrogate.

Form Details

Total fields: 25
Auto-fillable: 14 (56%)
Time without BeneFill: 25 minutes
Time with BeneFill: 7 minutes
Time saved: 18 minutes
Filled by: both
Frequency: one time
State-specific: Yes — form may vary by state

Fill this form with BeneFill

Auto-fill 56% of fields from your profile. Save 18 minutes. Download a real PDF.

14 of 25 fields56% auto-filled

Start Filling Upload Your Copy Instead

Where to Submit This Form

🏢

Completed with your physician and kept in your medical record

MOLST/POLST must be signed by both the patient (or authorized representative) and the treating physician, NP, or PA.

Filing Deadline

Complete when you have a serious illness or advanced frailty. Should be reviewed with each change in care setting or health status.

Required Attachments

📎 Physician/NP/PA signature (required for validity)
📎 Patient or authorized representative signature
📎 No additional attachments — this is a standalone medical order

Processing Time

Immediate. This is a medical order, not a form that is submitted for processing. It is effective as soon as signed.

What Happens Next

The original form travels with the patient across care settings. Emergency responders, hospitals, and nursing facilities must honor it. Keep it visible and accessible (e.g., on the refrigerator at home).

Tips for This Form

✓ MOLST/POLST is for people with serious illness — it is NOT a substitute for an advance directive for healthy adults
✓ Review the form with your physician whenever your health status changes significantly
✓ The form must be on the official state-issued colored paper (usually bright pink or green) to be honored by EMS
✓ Transfer the original form when you move between care settings (home, hospital, nursing facility)

More Advance Planning Forms

Advance Directive / Living Will

State-specific · State Law (forms from AARP, state bar associations, hospitals)

Legal document specifying medical treatment preferences when the individual is unable to make decisions. Requirements for witnesses and notarization vary by state. Free state-specific forms available from AARP and state agencies.

Living Will (State-Specific)

Varies by state · State Legislatures / State Bar Associations

Written declaration of preferences regarding life-sustaining treatment, artificial nutrition and hydration, and comfort care when terminally ill or permanently unconscious. Legally distinct from healthcare proxy in many states.

Healthcare Power of Attorney / Healthcare Proxy

State-specific · State Law

Designates a trusted person (agent/proxy) to make healthcare decisions when the individual cannot. May be part of a combined advance directive or a separate document depending on state law.

POLST (Physician Orders for Life-Sustaining Treatment)

POLST · State Health Departments (46 states as of 2026)

Medical order (not just a directive) specifying life-sustaining treatment preferences. Actionable by EMS. For patients with serious life-limiting illness or advanced frailty. Works alongside advance directives.

MOST / POST / COLST (State Variants)

MOST / POST / COLST · Various State Health Departments

State-specific variants of POLST: Medical Orders for Scope of Treatment (MOST), Physician Orders for Scope of Treatment (POST), Clinician Orders for Life-Sustaining Treatment (COLST). Functionally equivalent to POLST.

Do Not Resuscitate (DNR) Order

DNR (state-specific) · State Departments of Health

Medical order directing healthcare providers not to perform CPR if the patient's heart stops or they stop breathing. Cannot be created by the patient alone; requires physician signature. Comfort care always continues.

Not sure which forms you need?

Tell our assistant about your situation and we'll find the right forms for you.

Chat with Form Assistant

Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Health Departments (e.g., New York) or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.