“Medical Orders for Scope of Treatment”, known as (MOST),  is a facilitated conversation process with patients and their significant others and/or designated medical power of attorney. These medical orders are designed to:

      • Promote patient autonomy by documenting treatment preferences and converting them into a physician’s orders;
      • Clarify treatment intentions and minimize confusion regarding a patient’s treatment preferences, covering a full range of options such as CPR, level of care, breathing and nutritional support.
      • Help designated others understand their role when the patient is no longer able to communicate or make decisions for his/herself.
      • Facilitate appropriate treatment by emergency medical services personnel; and
      • Enhance the HIPAA compliant transfer of patients’ wishes for care at the end of life between healthcare professionals and healthcare settings.

The MOST form puts the advance directive into action by translating the patient’s treatment wishes into a medical order, centralizing information, facilitating record keeping, and ensuring transfer of appropriate information among healthcare professionals and across care settings.  The conversation is led by a trained facilitator, typically a nurse social worker or clergy, and is certified by your doctor as it is completed.

The MOST process and form are intended to complement advance care planning not replace the living will, medical power of attorney form or an Out of Hospital Do Not Resuscitate form.

At different stages of life, different levels of planning are meaningful.  The MOST conversation and form are appropriate only for patients nearing the end of life with a terminal diagnosis, the frail and/or elderly and those whom the physician would not be surprised if they were to die in the next year.