Can the MOST be signed electronically?

Yes. Electronic signatures that meet ESIGN (15 U.S.C. ch. 96) and applicable state electronic transaction law are generally valid. For healthcare forms, ensure the eSignature platform supports HIPAA protections and adequate signer authentication.

Who can change or revoke a MOST?

A competent patient may request changes at any time. If the patient lacks capacity, an authorized surrogate or clinician (per facility policy) may revise the MOST following applicable legal authority, and the change should be documented and signed.

Is a notary required for the MOST?

Most states do not require notarization for clinician-signed medical orders, but local facility policies or paired advance directives may have witness or notarization preferences. Check facility and state guidance when in doubt.

How do EMS providers find the MOST?

Provide a copy to EMS, include MOST status in the EHR, and use visible wristband or refrigerator magnet programs where available so first responders can locate orders quickly.

What if the MOST conflicts with an advance directive?

A MOST is a medical order and generally governs immediate medical care. Where conflicts occur, clinicians should reconcile documents and document the rationale; facility policy and state law guide priority rules.

Can a clinician refuse to follow a MOST?

Clinicians must make reasonable efforts to follow valid medical orders. In rare cases of conscientious objection or clinical inconsistency, document the reason, provide alternative care plans, and arrange timely transfer if necessary.

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Colorado Medical Orders for Scope of Treatment

Colorado Medical Orders for Scope of Treatment

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

What the Colorado Medical Orders for Scope of Treatment is and when it's used

The Colorado Medical Orders for Scope of Treatment (MOST) is a clinician-signed medical order set that records a patient’s treatment preferences for life-sustaining interventions across care settings. MOST translates a patient’s goals of care—such as preferred cardiopulmonary resuscitation (CPR), intubation, antibiotic use, and feeding—into orders that emergency responders, hospitals, and long-term care providers follow. It is intended for patients with serious illness or frailty for whom rapid decisions about interventions would be required, and it complements advance directives by creating immediately actionable medical orders.

Why completing a Colorado MOST matters for patients and providers

A completed MOST ensures a patient’s treatment preferences are documented as medical orders, reducing unwanted interventions and aligning care with goals across settings.

Who normally completes and relies on the Colorado MOST

The MOST is completed by the treating clinician in consultation with the patient or an authorized decision-maker; it is then signed by the clinician to become an actionable medical order.

Primary care and hospital physicians who determine medical orders
Nurse practitioners and physician assistants who are authorized to sign orders
Patients, legally authorized representatives, and surrogate decision-makers

Core elements included in a professional Colorado MOST

A complete MOST contains standardized sections that convert patient preferences into clear, time‑sensitive medical orders. Each element is designed to be brief, explicit, and clinically actionable so providers can make urgent decisions aligned with patient goals.

Patient identification

Full legal name, date of birth, and medical record number to ensure orders follow the correct patient across systems and facilities.

Goals of care

A concise statement of the patient’s primary goals (comfort-focused, limited interventions, or full treatment) that frames subsequent orders and clinical decision-making.

CPR and resuscitation

A clear order about cardiopulmonary resuscitation (attempt or do not attempt) specifying the intent for immediate responders and in-hospital teams.

Medical interventions

Orders about intubation, mechanical ventilation, vasopressors, and ICU transfer where appropriate to reflect the patient’s tolerance for invasive treatment.

Antibiotics and artificial nutrition

Guidance on antibiotic use and feeding tubes to align infection and nutrition decisions with patient values and prognosis.

Signatures and dates

Clinician signature, printed name, license or credential, and signer date plus patient or surrogate signature when required to confirm the conversation and consent.

Step-by-step: how to complete the Colorado MOST with the patient

Use this sequence to conduct the conversation, document decisions, and finalize the MOST so it is immediately actionable.

01

Discuss goals: Elicit values and prognosis, clarifying what outcomes matter most to the patient.
02

Review options: Explain likely benefits and burdens of CPR, ventilation, antibiotics, and feeding interventions.
03

Record choices: Select specific orders that reflect the chosen goals and avoid open-ended phrasing.
04

Sign and distribute: Clinician signs the document; give copies to patient, chart, and relevant care teams.

How to configure an online MOST workflow for consistent completion

Set up a repeatable digital workflow to capture the clinician conversation, required fields, and distribution for all completed MOST forms.

Field	Configuration
Required fields	Make patient name, DOB, clinician signature, and orders mandatory
Conditional fields	Show surrogate signature only when the patient lacks capacity
Authentication	Require clinician login with SSO and MFA for order validation
Automatic routing	Send final PDF to chart, patient, and hospice/EMS as configured

Technical considerations for digital MOST handling

Digital workflows should support secure uploads, required fields, authenticated clinician signatures, and automatic distribution to the medical record.

File formats: PDF, DOCX supported
Integrations: EHR, Google Workspace, Box, NetSuite
Authentication: SSO, MFA, audit trail

Typical end-to-end routing for a completed MOST

A clear routing process prevents gaps: create the order, sign, store, and notify stakeholders so providers and EMS can access the MOST when needed.

Create: Clinician completes form during patient encounter or telehealth visit
Sign: Clinician signs electronically or on paper; patient/surrogate signs if appropriate
Upload: Save the completed MOST to the patient chart and document directory
Notify: Provide copies to patient, family, EMS, and receiving facilities as required

Timelines and recommended review cadence for the MOST

Maintain currency by scheduling reviews and noting events that trigger reassessment so orders remain aligned with the patient’s condition.

Initial completion:

Complete during an encounter when the patient's clinical status warrants—no fixed state filing deadline

Periodic review:

Review and update at major health status changes or at least annually

After hospitalization:

Reassess within 7–30 days after discharge if treatment goals may have changed

Transfer of care:

Provide MOST copy at transfer; receiving facility should document receipt

Revocation or change:

Patient or authorized surrogate may request change at any time; document and sign amendments

Key milestones from discussion to active medical order

Numbered milestones show the common stages a MOST follows from conversation to use in emergencies.

01

Shared decision conversation

Discuss prognosis and options with patient and family before recording preferences

02

Order entry

Clinician translates preferences into explicit medical orders on the MOST form

03

Clinician authentication

Clinician signs the MOST to make it an official medical order

04

Distribution

Place MOST in chart and provide copies to EMS and other care partners

Essential data points to include on the MOST

Patient name: Full legal name

Date of birth: MM/DD/YYYY

Medical record: Chart or MRN

Clinician name: Printed name and credentials

Signatures: Clinician and patient/surrogate

Order dates: Signature and effective dates

Common mistakes to avoid when preparing a MOST

Leaving orders vague or conditional, which can cause confusion in emergencies and lead to inappropriate interventions.
Failing to include clinician credentials or dated signatures, which may render the order non-actionable across care settings.
Not providing a copy to EMS or the receiving facility, preventing first responders from accessing the patient’s preferences.
Omitting a documented conversation or rationale, making it difficult for surrogates and clinicians to verify informed decisions.

Risks and legal implications of an incomplete or incorrect MOST

Clinical risk: Unintended life-sustaining treatments

Legal exposure: Potential liability for failing to follow documented patient orders

Transfer delays: Care transitions hindered by missing or inconsistent orders

Surrogate conflicts: Disputes if the MOST does not reflect patient preferences

Recordkeeping lapses: Missing documentation may complicate audits or reviews

Regulatory scrutiny: Noncompliance with state health department guidance

Comparison: signNow and common eSignature vendors for clinical order workflows

Cost and feature differences matter when choosing an eSignature provider for health-care workflows. The table below lists starting prices, trial availability, bulk send support, audit trail, HIPAA compliance, and envelope caps for common providers.

	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	Varies	Varies	Varies
Bulk Send	Yes (Business Premium)	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes (BAA available)	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year limit	Varies by plan	Varies by plan	Varies by plan

Who is authorized to sign the Colorado MOST

Attending clinician

An authorized physician, nurse practitioner, or physician assistant who has examined the patient and discussed goals of care signs the MOST to convert preferences into an actionable medical order.

Patient or surrogate

The patient signs when capable; if incapacitated, an authorized surrogate or legally appointed decision-maker may sign or confirm the orders per state rules and facility policy.

Real-world scenarios illustrating MOST use

Two concise examples show when and how MOST orders are typically completed and applied in practice.

Hospital care transition

An older patient with progressive heart failure discusses goals with the hospitalist

The team documents 'comfort-focused' goals and no ICU escalation
The signed MOST travels with the patient to the rehabilitation facility, where staff follow the orders and avoid unnecessary ICU transfer, aligning care with the patient’s preferences.

Nursing facility admission

On admission to a nursing facility, staff review advance directives and complete a MOST after discussion

The facility records 'limited interventions' and clarifies antibiotic preferences
EMS and facility staff use the order during an on-site acute event, preventing unwanted aggressive treatment.

Frequently asked questions about completing and using the Colorado MOST

Answers to common questions address signature authority, electronic signing, updates, and interactions with advance directives and EMS protocols.

Need help? Contact support

Can the MOST be signed electronically?
Yes. Electronic signatures that meet ESIGN (15 U.S.C. ch. 96) and applicable state electronic transaction law are generally valid. For healthcare forms, ensure the eSignature platform supports HIPAA protections and adequate signer authentication.
Who can change or revoke a MOST?
A competent patient may request changes at any time. If the patient lacks capacity, an authorized surrogate or clinician (per facility policy) may revise the MOST following applicable legal authority, and the change should be documented and signed.
Is a notary required for the MOST?
Most states do not require notarization for clinician-signed medical orders, but local facility policies or paired advance directives may have witness or notarization preferences. Check facility and state guidance when in doubt.
How do EMS providers find the MOST?
Provide a copy to EMS, include MOST status in the EHR, and use visible wristband or refrigerator magnet programs where available so first responders can locate orders quickly.
What if the MOST conflicts with an advance directive?
A MOST is a medical order and generally governs immediate medical care. Where conflicts occur, clinicians should reconcile documents and document the rationale; facility policy and state law guide priority rules.
Can a clinician refuse to follow a MOST?
Clinicians must make reasonable efforts to follow valid medical orders. In rare cases of conscientious objection or clinical inconsistency, document the reason, provide alternative care plans, and arrange timely transfer if necessary.

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