Medical Orders for Scope of Treatment (MOST)

The Medical Orders for Scope of Treatment (MOST) form is a medical directive signed by a patient or his or her legal representative and the patient’s physician, nurse practitioner, or physician assistant. Based on the national Physician Orders for Life-Sustaining Treatment (POLST) paradigm [1], the North Carolina MOST form is a bright pink document that instructs health care providers about the appropriate application of medical treatments in both emergency and nonemergency situations. Section A of the MOST form indicates whether cardiopulmonary resuscitation should be attempted (if the patient has no pulse and is not breathing), and sections B, C, and D outline the treatments the patient would want in the event of seriously illness that does not involve cardiopulmonary arrest [2]. The MOST form does not replace an advance directive (a living will or health care power of attorney); rather, it translates a patient’s preferences for treatments into medical orders and conveys those orders across different settings of care. The North Carolina MOST form was established by statute in 2007 [3]. The form is primarily intended for seriously ill patients who are at high risk of losing their ability to make medical decisions or for those who already rely on a surrogate to make medical decisions. The MOST form empowers the patient or the patient’s legal representative to delineate treatment preferences regarding cardiopulmonary resuscitation, intubation with mechanical ventilation, and intensive care. Alternatively, the patient can specify a wish to avoid future hospitalizations and to receive only comfort-focused care. In addition