Maryland MOLST Form: How It Differs from an Advance Directive and DNR

MOLST Is Not Another Name for a Living Will

The most dangerous confusion in Maryland end-of-life planning is treating a MOLST form and an advance directive as interchangeable. They serve completely different purposes.

An advance directive is a legal planning document you complete while healthy. It names a healthcare agent and records your treatment preferences for the future. A MOLST (Medical Orders for Life-Sustaining Treatment) is a medical order — signed by a physician, nurse practitioner, or physician assistant — that tells emergency clinicians exactly what to do right now.

This distinction is not academic. During a cardiac or respiratory emergency, EMS clinicians are legally prohibited from honoring a standard advance directive or living will. They must perform full resuscitation unless a valid, signed MOLST form or approved EMS/DNR order is physically present or verified through an official Medic Alert bracelet.

What the Maryland MOLST Covers

The MOLST form contains nine structured sections addressing specific interventions:

• CPR — whether to attempt resuscitation if your heart stops
• Artificial ventilation — whether to use mechanical breathing support
• Blood transfusions — whether to accept or decline
• Hospitalization transfers — whether to transfer from a facility to a hospital
• Diagnostic medical testing — whether to pursue additional diagnostics

Since January 1, 2013, the MOLST form replaced the historical EMS/DNR order in Maryland. Pre-existing EMS/DNR forms remain legally enforceable, but all new orders use the MOLST format.

DNR vs. MOLST: The Relationship

A DNR (Do Not Resuscitate) order is not a standalone document in Maryland. It is Section 1 of the broader MOLST form. When your physician checks the "Do Not Attempt Resuscitation" option in the MOLST, that section functions as your DNR.

If someone searches for a "Maryland DNR form," what they actually need is a MOLST. The old standalone EMS/DNR forms are no longer issued, though existing ones still carry legal weight.

POLST vs. MOLST: Same Concept, Different Name

Many national resources refer to "POLST" (Physician Orders for Life-Sustaining Treatment). Maryland uses "MOLST" instead — it is the same concept adapted to Maryland's specific regulatory framework. If you search for "Maryland POLST," you are looking for the MOLST.

How to Get a MOLST Form

You cannot fill out a MOLST yourself. It must be completed and signed by a licensed clinician based on a clinical conversation with you or your authorized healthcare agent.

By law, Maryland healthcare facilities are required to complete or review a MOLST form when you are admitted to a nursing home, assisted living facility, home health agency, hospice program, kidney dialysis center, or hospital. However, you do not need to wait for a facility admission — you can request a MOLST conversation with your primary care physician at any time.

The completed MOLST is portable. It travels with you across care settings and must be honored by EMS clinicians, hospice workers, hospital personnel, and nursing home staff.

Making Your MOLST Visible in an Emergency

A MOLST is useless if paramedics cannot find it during a crisis. Maryland offers several visibility options:

• Medic Alert bracelet or necklace — a specialized metal EMS/DNR identification through Medic Alert
• MIEMSS plastic bracelet — designed to hold the official MOLST order insert
• Refrigerator placement — many EMS protocols check the refrigerator door for posted medical orders in home emergencies
• Digital access — upload your advance directive and MOLST information to MyDirectives.com so connected hospital systems can verify your wishes electronically

The Gap Between Your Advance Directive and Your MOLST

Your advance directive tells your physician what you want. Your MOLST tells EMS what to do. Without both, there is a gap — your wishes are documented but not actionable in the moments that matter most.

The Maryland Advance Directive & Living Will Kit includes a MOLST preparation worksheet designed to organize your treatment preferences into the format your physician needs for the clinical conversation. It bridges the gap between your written wishes and the enforceable medical orders that emergency responders actually follow.

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