Rhode Island MOLST, Comfort One, and DNR: Clinical Protocols Explained

An advance directive tells doctors what you want. A MOLST form, Comfort One bracelet, or DNR order tells emergency responders what to do right now. These are medical orders, not legal planning documents — and Rhode Island has specific programs for each.

MOLST: Medical Orders for Life-Sustaining Treatment

The MOLST is Rhode Island's version of what some states call POLST. Authorized under R.I. Gen. Laws § 23-4.11-3.1, it is a standardized form printed on bright pink cardstock that contains immediate, actionable medical orders.

Who it's for: Patients with a terminal illness or advanced frailty. The MOLST is not intended for healthy adults doing general advance planning — that's what the Living Will and DPOAH are for.

How it works: A MOLST-qualified healthcare provider (physician, nurse practitioner, APRN, or physician assistant) completes the form after an in-person consultation with the patient or their legal healthcare decision-maker. Both the provider and the patient (or decision-maker) must sign it.

What it covers: The MOLST addresses specific clinical interventions — CPR, mechanical ventilation, antibiotics, artificial nutrition, and hospital transfer preferences. Any section left blank defaults to full treatment for that intervention.

Where it applies: The MOLST is active immediately upon signature and follows the patient everywhere — hospital, nursing home, ambulance, and home. Since January 2014, all Rhode Island nursing facilities, assisted living residences, hospices, dialysis centers, home health agencies, and hospitals are legally required to accept MOLST forms and offer patients the opportunity to complete one during admission or discharge.

Changing or revoking it: A patient with decision-making capacity can void a MOLST at any time, even verbally. To physically void the form, a clinician draws a diagonal line through the sections, writes "VOID" in large letters, and signs and dates the change.

MOLST vs Advance Directive: They're Not the Same Thing

Complete your advance directive first. The MOLST comes later, when your medical situation calls for it.

Comfort One: Rhode Island's Out-of-Hospital DNR Program

The Comfort One program, administered by the Rhode Island Department of Health Division of EMS, is the state's out-of-hospital Do Not Resuscitate system.

The bracelet: When a physician certifies a terminal patient's DNR status, the patient can receive a non-transferable, serialized metal Comfort One bracelet. This is not jewelry — it is a legally recognized medical identifier.

What it does: When EMTs respond to a cardiac or respiratory arrest at a home, they are legally required to perform full CPR and resuscitation unless they see a Comfort One bracelet or a documented DNR order. The bracelet provides EMTs with civil and criminal immunity when they honor the DNR and withhold resuscitation.

How to get one: Talk to your physician. The doctor must complete the certification, and the bracelet is issued through the program. A DNR can also be recorded directly in Section A of the MOLST form as an alternative to the bracelet.

Standard DNR Orders in Rhode Island

A standard Do Not Resuscitate order instructs healthcare professionals to withhold CPR in the event of cardiac or respiratory arrest. In Rhode Island, a DNR can exist as:

1. A standalone medical order in your hospital or facility chart
2. Section A of a completed MOLST form
3. A Comfort One bracelet for out-of-hospital settings

A DNR does not mean "do not treat." It specifically addresses resuscitation — CPR, defibrillation, intubation, and cardiac medications administered during a code. All other medical treatments continue unless separately addressed.

What You Should Do

If you are a healthy adult planning ahead, complete your DPOAH and Living Will. Discuss with your healthcare agent what your preferences would be if you became terminally ill.

If you or a family member has a terminal diagnosis or advanced frailty, talk to the treating physician about completing a MOLST form. If the patient will be at home and wants to ensure EMTs honor a DNR, ask about the Comfort One bracelet.

Frequently Asked Questions

Can I complete a MOLST myself? No. Unlike an advance directive, a MOLST requires a healthcare provider's clinical involvement and signature. You cannot fill one out independently.

Does a MOLST replace my advance directive? No. The MOLST covers specific clinical interventions and is designed for patients who are already seriously ill. Your advance directive covers broader healthcare planning and designates who speaks for you. Complete your advance directive first; add a MOLST when your medical situation calls for it.

What if the MOLST and my advance directive conflict? If the documents give different instructions, Rhode Island law generally follows the most recently executed document as reflecting the patient's current wishes. This is why updating both documents when your preferences change is important.

Can out-of-state EMTs honor a Rhode Island MOLST? MOLST and POLST forms are state-specific medical orders. While neighboring states generally have reciprocity agreements, a Rhode Island MOLST may not be automatically recognized in another state. If you spend significant time elsewhere, discuss MOLST portability with your physician.

The Rhode Island Advance Directive & Living Will Kit includes a MOLST and Comfort One reference guide so you understand when and how to transition from legal planning documents to clinical protocols.

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