MOST Form in Kentucky: Medical Orders for Scope of Treatment Explained

A living will tells a hospital what you want. A MOST form tells every healthcare provider — EMS, emergency rooms, nursing homes, home health aides — exactly what to do, right now, without interpretation.

Kentucky's Medical Orders for Scope of Treatment (MOST) form, authorized under KRS 311.6225, is a physician-signed medical order for patients with advanced chronic progressive illness or a life expectancy of less than one year. It's one of the most powerful end-of-life documents in Kentucky law, and most families don't know it exists until a doctor hands them one during a crisis.

Who Qualifies for a MOST Form

Not everyone can get one. The MOST form is specifically designed for:

• Patients diagnosed with a terminal illness
• Patients with a life expectancy of one year or less
• Patients with an advanced chronic progressive illness (advanced COPD, late-stage heart failure, end-stage renal disease, advanced dementia)

If you're a healthy 55-year-old planning ahead, the MOST form isn't appropriate — a standard living will and healthcare surrogate designation is the right starting point. The MOST form enters the picture when a physician determines that your condition has progressed to the point where specific medical orders need to be in place.

What the MOST Form Covers

The MOST form goes far beyond a simple "do not resuscitate" instruction. It addresses four categories of treatment:

Section A — Cardiopulmonary Resuscitation (CPR). If your heart stops or you stop breathing, should paramedics attempt full resuscitation? Options range from full CPR to DNR (allow natural death).

Section B — Medical Interventions. If you're found with a pulse but in serious condition, what level of treatment do you want? Options include full treatment (ICU, intubation, mechanical ventilation), limited interventions (IV fluids, cardiac monitoring, but no intubation), or comfort measures only (pain management, oxygen for comfort, transfer to hospital only if comfort needs can't be met).

Section C — Antibiotics. Should antibiotics be used to treat infections? Options range from full antibiotic treatment to antibiotics only for comfort (reducing symptoms like fever) to no antibiotics at all.

Section D — Artificially Administered Fluids and Nutrition. Should feeding tubes or IV hydration be used? Options include long-term tube feeding, a defined trial period, or no artificial nutrition.

Why It's Printed on Pink Paper

This isn't decorative. Kentucky's MOST form is printed on bright pink paper specifically so it's immediately recognizable to EMS personnel, hospital staff, and nursing home workers. In an emergency, a responder rifling through a home care binder or a patient chart can spot the pink form instantly. If your MOST form gets photocopied onto white paper, it may not be immediately recognized — always keep the original pink copy.

MOST vs. Living Will vs. EMS DNR

The critical point: under Kentucky law, if your MOST form and your advance directive conflict, your advance directive takes precedence. This means your general wishes in the living will override the physician orders on the MOST form. That's why both documents need to be consistent.

How to Get a MOST Form Completed

1. Initiate the conversation with your physician. Your doctor or the medical team at your care facility typically raises the MOST form when your condition reaches the qualifying threshold. But you or your healthcare surrogate can bring it up first.

2. Discuss each section. Your physician should walk through all four categories with you (or your surrogate if you've lost capacity). These aren't yes/no questions — they involve understanding tradeoffs between comfort and intervention.

3. Both signatures required. The MOST form must be signed by the physician and by you (or your designated healthcare surrogate). It's a medical order, not a unilateral patient form.

4. Place it in your medical chart and keep the original with you. The pink form should travel with you — on the refrigerator at home, in your chart at the nursing home, and with you during any ambulance transfer.

5. Review periodically. Your medical situation changes, and your MOST form should change with it. A MOST completed two years ago during a cancer scare may not reflect your current wishes if you've since recovered or if your condition has progressed.

When Families Disagree About the MOST Form

The MOST form is a physician order. Once signed, it's legally binding on healthcare providers regardless of what other family members think. But disagreements still happen — especially when the patient has lost capacity and the surrogate's decisions feel wrong to other relatives.

If a dispute escalates, family members can petition the District Court for judicial intervention. But while that petition is pending, the MOST form remains in effect. This is why getting family alignment before completing the form matters as much as the form itself.

Get the Complete Kentucky Advance Directive Kit

The MOST form doesn't work alone. It needs to align with your living will, your healthcare surrogate designation, and your EMS DNR order. The Kentucky Advance Directive & Living Will Kit helps you coordinate all of these documents, walks you through the conversation with your physician, and includes worksheets for every decision point on the MOST form.

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