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Medical Orders for Scope of Treatment (M.O.S.T.) Program

The District of Columbia Medical Orders for Scope of Treatment (MOST) program was established  DC City Council by the Health-Care Decisions Amendment Act of 2015, and replaces the Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate (CCO-DNR) program.  The MOST program provides a more comprehensive approach, empowering terminally-ill patients the right to make decisions on their end-of-life care options, in consultation with their DC-licensed authorized healthcare provider (Physician (MD/DO) or Advanced Practice Registered Nurse (APRN) only).  
 
The MOST program is administered by the D.C. Department of Health (DC Health) Health Emergency Preparedness and Response Administration’s (HEPRA) EMS Division. As part of the implementation plan, the EMS Division has established an advisory committee of multi-disciplinary healthcare providers and stakeholders to assist in development of the MOST form as well as provide public awareness. 
 
The Medical Orders for Scope of Treatment (MOST) Form 
The MOST Form is divided into four (4) sections (A-D), simplifying patient preferences for life-sustaining treatments, including: Cardio-Pulmonary Resuscitation (CPR), Medical Interventions/Treatment Options, Antibiotics, and Medically-Assisted Nutrition.  Any incomplete section of the MOST form implies full-treatment for that section.  The form must be completed by the patient or their authorized representative and an authorized DC-licensed healthcare provider to be considered valid.   

The DC MOST Form is made publically available on our website where it may be downloaded and printed. It is advsied that, the form should be printed on bright colored paper (i.e. bright blue paper) so that it can be easily located and differentiated from other medical documents in the event of a medical emergency, and to alert first responders, EMS, and other healthcare providers that the patient participates in the MOST program. 

All copies of the original MOST Form serve as a legal document. The patient must have a copy on their person or in the immediate visible vicinity in order for it to be honored. In addtiion, a copy must be kept on file in the patient's medical record as well as with DC Health's MOST Program. Completed Forms should be returned to DC Health via email at [email protected]

Portability

A copy of the patient’s MOST form should follow the patient in any setting and must be honored.  This includes, but is not limited to: hospitals, long-term care facilities, clinics, hospice, private medical practices, and the patient’s home. The portability of the form provides continuity and assurance that if the patient is incapacitated and transferred to a new health care setting, the patient’s End-of-Life wishes will be easily recognized and respected.  It is required that, within seventy-two (72) hours of the patient’s transfer to a healthcare setting, that the MOST form be reviewed by an authorized DC-licensed healthcare provider. 

Revocation of MOST

The MOST form may be revoked at any time by the patient or patient’s authorized representative.  To cancel the form, write the words “VOID” across the form and put a line through “Medical Orders for Scope of Treatment” at the top of the page.  Revocation can also occur verbally to EMS responders or an authorized DC-licensed healthcare provider.  Following the revocation, the patient’s medical record should be updated accordingly. 

 
Resources
Compassion and Choices is the nation’s oldest, largest and most active nonprofit working to improve care and expand options for the end of life.
 
  • The National POLST Paradigm  is an approach to end-of-life planning that emphasizes patients’ wishes about the medical treatments they receive. 
Overviews
Having the Conversation
POLST and Pediatrics 
POLST and Advance Care Planning
Other