Is an electronic signature valid?

Yes. Electronic signatures are generally enforceable under the federal ESIGN Act (15 U.S.C. ch. 96) and state UETA where adopted; ensure the signer’s intent, consent, attribution, and reliable retention are documented.

Does HIPAA affect sharing MOSTs?

Yes. MOST forms are part of the medical record and must be handled under HIPAA privacy and security rules, with retention guidance per 45 CFR §164.530(j).

Who can sign if the patient lacks capacity?

A legally authorized surrogate or health care proxy may sign when the patient lacks capacity; attach documentation that establishes surrogate authority to avoid disputes.

How do I revoke or change a MOST?

The patient or authorized surrogate can revoke or replace the MOST at any time by completing a new form or providing written revocation; clinicians should document the change in the medical record.

Will EMS honor the MOST?

EMS protocols vary by jurisdiction; provide EMS with a clear, signed copy and confirm local EMS guidance to ensure adherence.

What if a signature is missing?

An unsigned MOST may not be treated as a valid medical order; obtain required clinician and patient or surrogate signatures before relying on the form in urgent situations.

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Colorado Medical Orders for Scope of Treatment

Colorado Medical Orders for Scope of Treatment

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Colorado Medical Orders for Scope of Treatment (MOST)

SEND FORM WITH PERSON WHENEVER TRANSFERRED OR DISCHARGED

Last Name

First Name/Middle Name

Date of Birth

Sex

Hair Color

Eye Color

Race/Ethnicity

A. CARDIOPULMONARY RESUSCITATION (CPR) Person has no pulse and is not breathing.

No CPR Do Not Resuscitate/DNR/Allow Natural Death Yes CPR Attempt Resuscitation/CPR

When not in Cardiopulmonary arrest, follow orders B, C, and D

B. MEDICAL INTERVENTIONS Person has pulse and/or is breathing.

Comfort Measures Only

Use medication by any route, positioning, and other measures to relieve pain and suffering. Use oxygen, suction and manual treatment of airway obstruction as needed for comfort. Do not transfer to hospital for life-sustaining treatment. Transfer only if comfort needs cannot be met in current location; EMS-Contact medical control.

Limited Additional Interventions

Includes care described above. Use medical treatment, IV fluids and cardiac monitor as indicated. Do not use intubation, advanced airway interventions, or mechanical ventilation. Transfer to hospital if indicated. Avoid intensive care; EMS-Contact medical control.

Full Treatment

Includes care described above. Use intubation, advanced airway interventions, mechanical ventilation, and cardioversion as indicated. Transfer to hospital if indicated. Includes intensive care. EMS-Contact medical control.

Additional Orders

C. ANTIBIOTICS

No antibiotics. Use other measures to relieve symptoms. Use antibiotics when comfort is the goal. Use antibiotics. Additional Orders

D. ARTIFICIALLY ADMINISTERED NUTRITION AND HYDRATION

Always offer food & water by mouth if feasible

No artificial nutrition/hydration by tube. Patient has executed a “Living Will” Patient has not executed a “Living Will” Defined trial period of artificial nutrition/hydration by tube.

Length of trial

Goal

Long-term artificial nutrition/hydration by tube. Additional Orders

E. DISCUSSED WITH:

Patient Agent under Medical Durable Power of Attorney Proxy (per statute C.R.S. 15-18.5-103(6)) Guardian Other

SUMMARY OF MEDICAL CONDITION(S):

SIGNATURE OF PATIENT, AGENT, GUARDIAN, OR PROXY BY STATUTE (MANDATORY)

Significant thought has been given to the desired scope of end-of-life treatment and these instructions. Preferences have been discussed and expressed to a health care professional. This document reflects those treatment preferences, which may also be documented in a MDPOA, CPR Directive, Living Will, or other advance directive (attached if available).

Signature

Name (Print)

Relationship / Surrogate status

Date Signed

Primary Contact Person for the Patient

Relationship and/or MDPOA, Proxy

Phone Number/Contact Information

Health Care Professional Preparing Form

Preparer Title

Phone Number

Date Prepared

Hospice Program (if applicable)

Address

Phone Number

Date Enrolled

Physician/APN/PA Signature (mandatory)

Colorado License #

Print Physician/APN/PA Name, Address and Phone Number

Date

HIPAA PERMITS DISCLOSURE OF THIS INFORMATION TO OTHER HEALTH CARE PROFESSIONALS AS NECESSARY

What the Colorado Medical Orders for Scope of Treatment is

The Colorado Medical Orders for Scope of Treatment (MOST) is a clinician-issued medical order that documents a patient’s current treatment preferences for life-sustaining interventions. It translates goals of care into actionable medical orders that travel with the patient across care settings. MOST forms are intended to be completed by a qualified clinician in collaboration with the patient or their authorized decision-maker, and they remain valid until changed or revoked by the patient or clinician.

Why a clear MOST matters for patients and providers

A completed MOST ensures that treatment preferences are recorded as medical orders, reducing confusion during emergencies. It supports patient-centered care, clarifies decisions for clinicians and EMS, and helps align interventions with stated goals.

Who completes and relies on a Colorado MOST

The MOST is completed when a clinician, patient, or authorized surrogate needs clear medical orders reflecting the patient’s goals.

Treating clinicians and hospital staff who must implement orders during care transitions.
Patients or authorized surrogates documenting preferences for life-sustaining treatment.
Emergency medical services and long-term care facilities that follow portable medical orders.

Primary signers and their roles

Patient / Surrogate

A competent adult patient signs when able, or an appointed health care proxy or legally authorized surrogate signs when the patient lacks capacity. The signer confirms treatment goals and preferences and may revoke or amend the MOST.

Clinician / Physician

A licensed clinician (physician, advanced practice clinician, or other authorized practitioner) must complete and sign the form to convert patient preferences into medical orders enforceable across care settings.

Key parts of a professional Colorado MOST form

A typical MOST contains discrete order sections so clinicians can quickly identify permitted and restricted interventions during urgent care.

Patient ID

Full legal name, date of birth, and medical record number to ensure the order applies to the correct patient and integrates with clinical systems.

General Goals

A concise statement of the patient’s overall goals of care—comfort-focused, limited interventions, or full treatment—used to guide downstream clinical decisions.

Cardiopulmonary Resuscitation

Clear choice regarding CPR (attempt vs. do-not-attempt) including any contextual limitations that affect when CPR should be attempted.

Airway and Ventilation

Order choices about intubation, mechanical ventilation, or noninvasive support with any qualifying parameters or time-limited trials.

Hospitalization and Transfers

Directives about whether to hospitalize, transfer, or manage in place, including any limits on aggressive care or ICU admission.

Signatures and Dates

Clinician signature, printed name, license or NPI, signature date, and patient or surrogate signature and date to validate the medical orders.

Required data elements on the MOST

Full legal name: Exact as ID

Date of birth: MM/DD/YYYY

Medical record number: Hospital MRN or equivalent

Clinician name: Printed name and license

Signature dates: Date patient and clinician signed

Proxy documentation: If surrogate signed, authority noted

Step-by-step: completing the Colorado MOST

Follow a clinician-led conversation, complete orders based on expressed goals, and ensure signatures and copies are distributed.

01

1. Discuss goals: Review prognosis and patient values.
02

2. Choose orders: Select specific interventions and limits.
03

3. Sign form: Clinician and patient or surrogate sign.
04

4. Distribute copies: Place in chart, give patient, notify EMS.

Configuring an online MOST workflow

Set up fields, signer roles, and distribution so completed MOST forms integrate with the patient record and are available to EMS.

Field	Configuration
Patient identification	Auto-fill from EHR via patient ID mapping
Signer roles	Define clinician and patient/surrogate signers
Authentication	Email + SMS code or stronger MFA
Delivery	Auto-save to chart and send PDF link

Where completed MOST forms should go

Ensure completed orders are placed where treating teams and emergency responders can access them quickly.

Medical record: File the original in the patient’s EHR.
Patient copy: Provide a printed or electronic copy to the patient.
Caregiver copy: Give caregivers a copy and clear instructions.
EMS access: Notify EMS providers when appropriate to honor orders.

Digital signing and file compatibility

Electronic completion requires PDF or DOCX support, secure signer authentication, and a reliable audit trail.

File formats: PDF and DOCX accepted
Integrations: EHR, Google Drive, Box, NetSuite
Authentication: Email, SMS, or MFA options

Timing considerations and when orders take effect

Record the effective date and review MOST orders whenever the patient’s health status or goals change.

Effective date:

Enter MM/DD/YYYY to record when orders begin

Periodic review:

Review at major clinical changes or annually

Revocation date:

Add date when a MOST is superseded or revoked

Transfer of care:

Confirm orders on admission or transfer

Emergency use:

Orders are immediately actionable when signed

Comparison of common eSignature vendors for MOST workflows

Typical criteria for MOST e-signature platforms include price, bulk send, audit trails, HIPAA support, and envelope or usage caps; signNow is listed first per platform comparison conventions.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Risks and legal consequences of errors on a MOST

Invalid signature: Order may not be followed

Mismatched identity: Patient misidentification risk

Incomplete orders: Leads to unwanted interventions

Failure to distribute: EMS or admitting teams unaware

HIPAA breach: Improper handling may violate HIPAA

Clinical liability: Care teams face medico-legal exposure

Common mistakes when preparing a Colorado MOST

Using imprecise language for interventions, which causes confusion for emergency clinicians and inconsistent application of patient wishes.
Failing to record exact signature dates or using an unsigned form, leaving orders unenforceable during urgent care.
Not providing copies to EMS, caregivers, or transfer destinations, so orders are unavailable when time-sensitive decisions arise.
Mismatching the patient name or record number from the EHR, which can cause the order to be overlooked or rejected.

Real-world scenarios where a MOST changed care

These two scenarios illustrate how a clearly completed MOST guides decisions across settings and reduces unwanted interventions.

Nursing Home to Hospital

An elderly resident clarified comfort-focused goals with staff and completed a MOST

EMS documented the order and did not initiate CPR on transport
The hospital honored the order, avoiding invasive ICU care inconsistent with the resident’s wishes and reducing distress for family and staff.

Home-Based Care Transition

A seriously ill patient appointed a surrogate and signed a MOST during a home visit

The surrogate carried a copy to the emergency department
Clinicians followed the MOST, providing comfort measures rather than aggressive interventions that the patient had refused.

Practical tips for accurate and efficient MOST completion

Adopt consistent documentation practices and ensure accessibility of orders during handoffs to reduce errors and improve adherence to patient wishes.

Use clear language

Select discrete options rather than narrative text so orders are unambiguous for clinicians and EMS.

Verify identity

Confirm full legal name and DOB against the EHR before signing to prevent misidentification.

Document authority

If a surrogate signs, attach power of attorney or legal proof of decision-making authority.

Distribute copies

Place the original in the chart, give patient copies, and notify EMS when appropriate.

Frequently asked questions about Colorado MOST forms

Below are common questions about validity, signatures, revocation, and electronic handling of MOST forms in Colorado.

Need help? Contact support

Is an electronic signature valid?
Yes. Electronic signatures are generally enforceable under the federal ESIGN Act (15 U.S.C. ch. 96) and state UETA where adopted; ensure the signer’s intent, consent, attribution, and reliable retention are documented.
Does HIPAA affect sharing MOSTs?
Yes. MOST forms are part of the medical record and must be handled under HIPAA privacy and security rules, with retention guidance per 45 CFR §164.530(j).
Who can sign if the patient lacks capacity?
A legally authorized surrogate or health care proxy may sign when the patient lacks capacity; attach documentation that establishes surrogate authority to avoid disputes.
How do I revoke or change a MOST?
The patient or authorized surrogate can revoke or replace the MOST at any time by completing a new form or providing written revocation; clinicians should document the change in the medical record.
Will EMS honor the MOST?
EMS protocols vary by jurisdiction; provide EMS with a clear, signed copy and confirm local EMS guidance to ensure adherence.
What if a signature is missing?
An unsigned MOST may not be treated as a valid medical order; obtain required clinician and patient or surrogate signatures before relying on the form in urgent situations.

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