To fill out the Ohio MOLST form, you sit down with a physician, advanced practice registered nurse, or physician assistant and work through five lettered sections that convert your treatment preferences into a signed medical order. You cannot download it and complete it on your own. The form becomes valid only when both you (or an authorized surrogate) and the healthcare professional sign Section E.
Ohio’s Medical Orders for Life-Sustaining Treatment form was authorized by Senate Bill 165 and is codified in Ohio Revised Code Chapter 2133. Unlike a living will, it is an active medical order that EMS crews, hospital staff, and nursing home nurses act on immediately.
Before You Start
Your physician, APRN, or PA supplies the form, usually during an office visit, hospital stay, or admission to a nursing or hospice facility. Regional systems also distribute their own versions; Hospice of Cincinnati, for example, uses a form specific to the Cincinnati area. If your provider has not raised the subject and you believe the MOLST applies to your situation, ask. The conversation itself is a billable clinical service under CPT codes 99497 and 99498, and Medicare covers it.
If you can make your own healthcare decisions, you sign for yourself. If you cannot, Ohio recognizes several surrogates: a healthcare agent named in a durable power of attorney for health care, a court-appointed guardian, next of kin, or, for a patient under eighteen, a parent, guardian, or legal custodian.
One warning before you begin marking boxes. A section left blank does not void the form, but it defaults to full treatment for that category. Skipping a section is effectively choosing the most aggressive option, so work through every section deliberately.
Section A: Cardiopulmonary Resuscitation
Section A applies only when you have no pulse and are not breathing. You have two choices: attempt resuscitation with full CPR, or do not attempt resuscitation. If you choose DNR here, a separate Ohio DNR form must be signed and attached to the MOLST. This is the most consequential checkbox on the page, because EMS personnel act on it in the first seconds of an emergency.
Section B: Medical Interventions
Section B governs situations where you still have a pulse or are breathing but need treatment. Three tiers are offered.
- Full Intervention authorizes all indicated treatments, including intubation, mechanical ventilation, cardioversion, and transfer to intensive care.
- Limited Additional Interventions allows IV fluids, cardiac monitoring, and airway support such as CPAP or BiPAP, but no intubation or mechanical ventilation. Hospital transfer is permitted; intensive care is avoided.
- Comfort Measures Only means medication for pain and symptom relief, oxygen, oral suctioning, and wound care, with no hospital transfer unless comfort needs cannot be met where you are.
The practical difference between Full and Limited is whether you are willing to be placed on a ventilator. If that matters to you, Section B is where you say so.
Section C: Antibiotics
Section C asks how aggressively you want infections treated. You can authorize antibiotics whenever clinically indicated, request a case-by-case decision when an infection actually occurs, or decline antibiotics entirely and rely on other comfort measures. An additional-orders line lets you add specific instructions. You might, for example, accept oral antibiotics but decline IV antibiotics.
Section D: Artificially Administered Hydration and Nutrition
Section D covers feeding tubes and IV hydration. Your three options are long-term tube feeding, a defined trial period to see whether tube feeding helps before committing, or no artificial nutrition or hydration at all. Whichever box you check, the form specifies that food and liquids by mouth should still be offered when feasible. This point confuses people often enough to flag: declining a feeding tube is not the same as declining a glass of water or a spoonful of pudding.
Section E: Basis for Orders and Signatures
Section E records who participated in the conversation and ties the form to your other advance planning documents. Checkboxes identify whether the discussion took place with you directly, with a healthcare agent under a DPOA-HC, with next of kin or another surrogate, with a court-appointed guardian, or with the parent of a minor. The section also notes the location of related documents: your living will, your DPOA-HC, and any Ohio DNR form. Pull those documents out before you sign so the locations recorded here are accurate.
Both the healthcare professional and the patient or surrogate must sign and date Section E. That signature pair is what transforms the paperwork from a worksheet into an enforceable medical order.
Where to Keep the Form
Once signed, the original MOLST needs to be somewhere emergency responders can find it fast. At home, many people put it on the refrigerator door, a location EMS personnel are trained to check. When you move between care settings, home to hospital, hospital to nursing facility, nursing facility to hospice, the form travels with you so the receiving staff can follow it immediately. Each facility should also incorporate it into your medical record, but the physical form itself moves with you rather than staying filed in one place.
Reviewing and Updating
An Ohio MOLST must be reviewed no later than one year after it is signed and at least once a year after that. A form that is not reviewed within those timeframes expires one year and one day from the date it was signed or last reviewed. You should also review it whenever you transfer between care settings or experience a significant change in health status.
Review does not automatically mean completing a new form. If your preferences have not changed, the existing form can simply be re-dated. If you want to make a substantive change, say, switching from Full Intervention to Comfort Measures Only, your provider completes a new MOLST. The new signed form supersedes every previous version.
Revoking Your MOLST
You can revoke the form at any time and in any manner that communicates your intent. Verbal revocation counts. Written revocation counts. No formal paperwork or witness is required. If you are under eighteen, your parent, guardian, or legal custodian can revoke on your behalf, and an authorized surrogate who signed the form can also revoke it. A revoked MOLST is retained in your medical record rather than destroyed, because providers need the historical record even after the orders are no longer active.
Is the MOLST Right for You
One boundary worth stating plainly: the MOLST is designed for people with serious, life-limiting health conditions, not for generally healthy adults. Good candidates include people with advanced chronic illness, progressive conditions such as end-stage kidney disease or ALS, terminal diagnoses, or significant frailty. Providers typically raise the MOLST conversation when a medical crisis within the next year is a realistic possibility. Residents of long-term care facilities are also common candidates, because the form gives nursing staff and visiting EMS crews clear, binding instructions that reach well beyond a simple DNR.