Delaware DMOST Form: How It Works with Your Advance Directive

If you've completed a Delaware advance directive and think your end-of-life wishes are covered, there's a critical gap: emergency medical personnel cannot legally honor it. When EMTs arrive at your home on a 911 call, they are required to perform full resuscitation — CPR, intubation, everything — unless they see a physician-signed medical order.

That medical order is the Delaware Medical Orders for Scope of Treatment (DMOST) form.

What the DMOST Form Actually Does

The DMOST is a physician-signed medical order printed on distinctive bright pink paper. Unlike your advance directive (a legal planning document), the DMOST is a clinical order that travels with you across care settings — home, ambulance, hospital, nursing home.

It covers four categories of treatment decisions:

Section A — Cardiopulmonary Resuscitation. Full CPR attempt, or Do Not Resuscitate (DNR). This is the section that controls what happens during a 911 call.

Section B — Medical Interventions. Three levels: full treatment (ICU, intubation, vasopressors), selective treatment (IV fluids and cardiac monitoring but no intubation), or comfort measures only (pain management and dignity).

Section C — Artificially Administered Nutrition. Whether to provide, trial for a limited time, or withhold feeding tubes and IV nutrition.

Section D — Antibiotics. Full treatment, limited use, or comfort-focused symptom management only.

Every section must be completed. If you leave one blank, healthcare providers are legally required to default to full treatment for that category — regardless of what your advance directive says.

The Critical Difference: Legal Document vs. Medical Order

Your advance directive is a legal document. It appoints your healthcare agent and states your general wishes. Physicians in a hospital setting will consult it when making treatment decisions.

Your DMOST is a medical order. It's signed by a physician, APRN, or PA, and it directly governs what clinicians and EMTs do in real time. No interpretation needed — it's a standing order.

Think of it this way: the advance directive is your plan. The DMOST is the instruction sheet that goes on the refrigerator door (many families post it there with the Bright Pink Envelope system so paramedics find it immediately).

Who Should Have a DMOST

The DMOST isn't for everyone. It's designed for people with:

• A serious terminal illness
• Advanced frailty
• A progressive chronic condition
• Any situation where full aggressive treatment conflicts with their goals of care

For a healthy adult completing advance planning, the advance directive alone is appropriate. The DMOST becomes relevant when your health condition changes and you want your treatment preferences immediately enforceable during emergencies.

How to Get a DMOST in Delaware

You cannot download and complete this form yourself. It requires:

1. A conversation with your physician, APRN, or PA about your diagnosis, prognosis, and treatment preferences
2. The clinician completes and signs the form based on your discussion
3. You (or your healthcare agent, if you've lost capacity) sign to confirm the orders

The DMOST is then printed on pink paper and distributed: original stays with you (at home or your facility), copies go to your medical record, your healthcare agent, and emergency contacts.

Making Your Advance Directive and DMOST Work Together

The advance directive should come first. It establishes your agent and documents your general wishes. When your health deteriorates, take your completed directive to your physician and ask them to translate your preferences into a DMOST.

If your advance directive says "no mechanical ventilation in a terminal condition," your DMOST should reflect that in Section B as "comfort measures only." Consistency between the two documents prevents confusion during emergencies.

If there's a conflict between an advance directive and a DMOST, the more recent document generally takes precedence — but avoiding conflicts in the first place is always better.

The Delaware Advance Directive & Living Will Kit includes a DMOST coordination guide with conversation scripts for requesting the form from your physician, plus instructions for the Bright Pink Envelope home storage system.

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