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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

Colorado Advance Directives Consortium, PO Box 270202, Littleton, CO 80127 v.7.10

• FIRST follow these orders, THEN contact Physician, Advanced Practice Nurse (APN), or Physician Assistant (PA), for further orders if indicated.

• These Medical Orders are based on the person’s medical condition & wishes.

• Any section not completed implies full treatment for that section.

• May only be completed by, or on behalf of, a person 18 years of age or older.

• Everyone shall be treated with dignity and respect.

A

Check

One Box

Only

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

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

B

Check

One Box

Only

MEDICAL INTERVENTIONS Person has pulse and/or is breathing.

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.

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.

Includes care described above. Use intubation, advanced airway interventions, mechanical ventilation, and cardioversion as indicated.

C

Check

One Box

Only

ANTIBIOTICS

Additional Orders:

D

Check

One Box

Only

ARTIFICIALLY ADMINISTERED NUTRITION AND HYDRATION

****Always offer food & water by mouth if feasible*****

(Length of trial: Goal: )

E

Check

All That

Apply

DISCUSSED WITH:

Other:

SUMMARY OF MEDICAL CONDITION(S):

(SECTION RESERVED FOR FUTURE USE)

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

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). To the extent that my prior advance directives do not conflict with these Medical Orders for Scope of Treatment, my prior advance directives shall remain in full force and effect.

(If signed by surrogate, preferences expressed must reflect patient’s wishes as best understood by surrogate.)

DIRECTIONS FOR HEALTH CARE PROFESSIONALS

COMPLETING THESE MEDICAL ORDERS

• Must be completed by a health care professional based on patient preferences and medical indications.

• These Medical Orders must be signed by a physician, advanced practice nurse, or physician assistant to be valid. Physician Assistants must include physician name and contact information.

• Verbal orders are acceptable with follow-up signature by physician or advanced practice nurse in accordance with facility policy.

• Original form strongly encouraged. Photocopy, fax, and electronic image of signed MOST forms are legal and valid.

USING THESE MEDICAL ORDERS

• Any section of these Medical Orders not completed implies full treatment for that section.

• A semi-automatic external defibrillator (AED) should not be used on a person who has chosen “Do Not Attempt Resuscitation.”

• Comfort care is never optional; Oral fluids and nutrition must always be offered if medically feasible.

• When comfort cannot be achieved in the current setting, the person, including someone with “Comfort Measures Only,” should be transferred to a setting able to provide comfort (e.g., pinning of a hip fracture).

• A person who chooses “Comfort Measures Only” or “Limited Additional Interventions,” should not be entered into a trauma system. EMS should contact Medical Control for further orders or direction regarding transfers.

• IV medication to enhance comfort may be appropriate for a person who has chosen “Comfort Measures Only.”

• Treatment of dehydration is a measure that may prolong life. A person who desires IV fluids should indicate “Limited Interventions” or “Full Treatment.”

• If a health care provider considers these orders medically inappropriate, he or she may discuss concerns with the patient or authorized surrogate and revise orders with consent of patient or surrogate.

• If a health care provider or facility cannot comply with the orders due to policy or personal ethics, the provider or facility must arrange for transfer to the patient to another provider or facility and provide appropriate care in the meantime.

• Proxy by statute is a decision maker selected through a proxy process according to C.R.S. 15-18.5-103(6), who may not decline artificial nutrition/hydration (ANH) without an attending physician and a second physician trained in neurology certifying that provision of ANH would merely prolong the act of dying and is unlikely to result in the restoration of the patient to independent neurological functioning.

REVIEWING THESE MEDICAL ORDERS

These Medical Orders should be reviewed regularly and when the person is transferred from one care setting or care level to another, there is a substantial change in the person’s health status, the person’s treatment preferences change, or when contact information changes.

REVIEW OF THIS MOST FORM

Review Date
Reviewer
Location of Review
Review Outcome

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

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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.

Why completing a Colorado MOST matters for patients and providers

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

After completion, the MOST is used by emergency medical services, hospital teams, nursing facilities, and hospice providers to guide immediate treatment decisions consistent with the patient’s stated goals.

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.


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