New York MOLST Form: What It Is, Who Needs It, and How It Works

If someone you love has a serious illness or is approaching the end of life, there is one specific New York State document that determines what paramedics and EMTs are legally required to do in an emergency. It is not a living will. It is not a Health Care Proxy. It is the MOLST form — and without it, first responders are required by law to begin resuscitation regardless of the patient's wishes.

Understanding the MOLST is essential for families managing a terminal illness, planning for advanced age, or trying to honor a loved one's wishes at the end of life.

What Is the MOLST Form?

MOLST stands for Medical Orders for Life-Sustaining Treatment. The official New York State form number is DOH-5003, issued by the New York State Department of Health.

The MOLST is not an advance directive in the conventional sense — it is a physician's medical order, not just a statement of preferences. Because it is a physician-signed medical order, it carries legal force that most advance directive documents do not have outside of a hospital setting.

The form is printed on bright pink paper — specifically to ensure immediate visibility to first responders when they enter a home or care facility.

What the MOLST Covers

The MOLST form addresses several critical treatment decisions:

• Cardiopulmonary Resuscitation (CPR): Whether resuscitation should be attempted if the heart stops
• Do Not Resuscitate (DNR): Instruction to withhold CPR
• Do Not Intubate (DNI): Instruction to avoid mechanical ventilation
• Other life-sustaining treatments: Hospitalization, artificial nutrition, IV fluids, and dialysis

The form has sections for both immediate decisions (what to do if the person stops breathing or loses a pulse) and longer-term decisions (what level of treatment to pursue over time).

Why the MOLST Matters Outside the Hospital

New York is one of relatively few states to have a standardized, legally binding out-of-hospital medical order form. The MOLST is the only authorized form in New York State for conveying a non-hospital DNR or DNI order to Emergency Medical Services.

Without a completed MOLST, EMS personnel arriving at a home, assisted living facility, or nursing home are legally obligated to initiate resuscitation efforts. A verbal statement by a family member, a Health Care Proxy document, or a letter from a physician is not sufficient to stop them. Only the MOLST — specifically, the pink DOH-5003 form signed by a physician — legally binds EMS to withhold resuscitation.

This is the core reason the MOLST exists: to give medical orders legal force in settings where emergency responders are the first point of contact.

The MOLST vs. the Health Care Proxy

These two documents serve different functions and should both be completed for seriously ill patients. They are not substitutes for each other.

The Health Care Proxy names a person. The MOLST gives that person's — or the patient's own — decision immediate medical order status. In practice, a patient's physician works with the patient (and often the Health Care Proxy agent) to complete the MOLST based on the patient's treatment preferences.

The MOLST vs. a Living Will

New York does not have a statutory living will form. Unlike most states, New York has no specific legislation creating a formal "living will" document. Instead, courts and medical providers treat living will instructions as "clear and convincing evidence" of a patient's wishes.

The MOLST effectively bridges this gap for end-of-life medical orders. It takes the patient's treatment preferences and converts them into legally actionable medical orders that EMS and medical personnel must follow.

Who Should Have a MOLST

The MOLST is not appropriate for everyone. It is specifically intended for people who:

• Have a serious illness with limited life expectancy
• Are elderly with significant health conditions
• Are at risk of cardiopulmonary arrest in the near future
• Have clear preferences about resuscitation and life-sustaining treatment

For a healthy adult with a long life expectancy, a Health Care Proxy is the appropriate document. The MOLST is for patients where the question of resuscitation is not hypothetical.

Where to Keep the MOLST

The bright pink form must be immediately accessible. Recommended locations:

• On the refrigerator door (common first-responder check point)
• At the bedside in a nursing home or care facility
• With the patient if transferring between care settings
• A copy should accompany the patient to any medical appointments

When a patient moves from home to hospital to rehab to nursing home and back, the MOLST must travel with them. Facilities are required to review the MOLST upon admission and cannot simply create a new one without patient or proxy consent.

How to Complete the MOLST

The MOLST must be completed with a physician, nurse practitioner, or other authorized prescriber. Patients cannot complete it on their own — it requires a medical professional's signature to be valid. The completing clinician must:

1. Have a conversation with the patient and/or Health Care Proxy about goals of care
2. Document the patient's wishes in the appropriate sections
3. Sign the form as a medical order
4. Provide the patient with the original pink form

The form is available from the NYS Department of Health at health.ny.gov/professionals/patients/patient_rights/molst/.

When a Family Member Disagrees

Family conflict over end-of-life decisions is common. If a completed MOLST exists and a family member disagrees with its instructions, the MOLST carries legal weight as a physician's medical order. EMS and medical personnel are bound to follow it.

Disputes should be directed to the hospital's ethics committee or, in some cases, to the courts. Attempting to hide or destroy a MOLST to prevent its use can carry legal consequences.

For families navigating the full range of New York end-of-life documents — Health Care Proxies, Powers of Attorney, MOLST forms, and the survivor benefits that follow — the New York Survivor Benefits Navigator provides a coordinated checklist and step-by-step guidance covering what happens before and after a death.

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