The Medical Orders for Scope of Treatment (MOST) program begins with a conversation between a healthcare professional and patient (individual) to determine preferences in key areas of life-sustaining medical treatment, including CPR, scope of treatment, and artificial nutrition.
The conversation may be guided by any healthcare professional with sufficient expertise to discuss the medical facts of the individual’s situation and likely risks and benefits of the various treatments described. The decisions are then documented on the MOST form: a 1-page, 2-sided document that consolidates and summarizes those individual preferences.
Individuals may refuse treatment, request full treatment, or specify limitations. These preferences may be previously or more extensively documented in advance directives, such as a Living Will, CPR Directive, or Medical Power of Attorney. Completion of a MOST does not revoke these instruments; all such other directives remain in effect. In general, the MOST overrules prior instructions only when they directly conflict.
A more recently completed MOST, however, invalidates all previous MOST forms. The MOST form was significantly revised in 2015; earlier forms remain valid unless and until they are superseded by a newer version. The MOST is primarily intended for elderly, chronically, or seriously ill individuals who are in frequent contact with healthcare providers.
No one is or may be required to complete a MOST.
The MOST must be signed by the individual or, if incapacitated, by the individual’s authorized Healthcare Agent, Proxy, or Guardian. It must also be signed by a physician, advanced practice nurse, or physician’s assistant. This signature translates patient preferences into medical orders, which must be followed regardless of the provider’s privileges at the admitting facility.
The standardized form can be easily and quickly understood by individuals, healthcare providers, and emergency personnel. The original is brightly colored for easy identification, but photocopies, faxes, and electronic scans are also valid.
The MOST form belongs to and “travels” with the individual; it must be honored in any setting: hospital, clinic, day surgery, long-term care or rehab facility, ALR, hospice, or at home. The portability of the form allows seamless documentation of treatment preferences and closes gaps as individuals transfer from setting to setting or experience delays in access to providers.
A section on the back prompts individuals and providers to regularly review, confirm, or update choices based on changing medical conditions and goals. Healthcare providers who cannot follow the orders for moral or religious reasons may decline, but they must arrange prompt transfer of the individual to another provider who will comply with the orders.
A master MOST form can be downloaded from the Colorado Advance Directives Consortium website: www.ColoradoAdvanceDirectives.com