Forms & Instructions

Sample of the Massachusetts MOLST form  - not for actual use.

During 2010, only clinicians in MOLST demonstration sites should use the MOLST form with suitable patients.  MOLST forms are signed by the clinician and patient (or patient's representative if the patient lacks capacity).  For information about obtaining MOLST forms for use with patients, contact the MOLST program at 508-856-5890.

MOLST Procedure for Clinicians - Checklist for using the MOLST form with patients.

Information for Patients and Caregivers after signing MOLST - Checklist for where to keep the MOLST form, who to inform about it, how to use MOLST in a medical emergency, etc.

Health Care Proxy Form - For use by all adults (aged 18 and older) to appoint a health care agent - the person authorized to make medical decisions for you in the future if you lose the ability to make those decisions.