{"data":{"id":"us-ky/krs-311.6225","jurisdiction":"us-ky","citation":"KRS 311.6225","heading":"Kentucky medical order for scope of treatment (MOST) form -- Eligible","body":"persons -- Scope -- Effect.\n(1) An adult with decisional capacity, an adult's legal surrogate, or a responsible party\nmay complete a medical order for scope of treatme nt directing medical\ninterventions. The form shall have the title \"Kentucky MOST, Medical Orders for\nScope of Treatment\" and an introductory section containing the patient's name and\ndate of birth and the statements:\n(a) \"The MOST form is voluntary.\";\n(b) \"A patient is not required to complete a MOST form.\";\n(c) \"A patient with capacity or their legal representative may void a MOST form\nany time by communicating that intent to the health care provider.\";\n(d) \"The original form is the personal property of the patient.\";\n(e) \"A facsimile, paper, or electronic copy is a legally valid form.\";\n(f) \"HIPAA permits disclosure of MOST to health care professionals as\nnecessary for treatment.\"; and\n(g) \"Any section not completed does not invalidate the form and indicat es a\npreference for full treatment for that section.\".\n(2) The remainder of the form shall be in substantially the following order and format\nand shall have the following contents:\n(a) Section A of the form shall direct cardiopulmonary resuscitation when a\nperson has no pulse and is not breathing by selection of one (1) of the\nfollowing:\n1. \"Attempt Resuscitation (CPR)\"; or\n2. \"Do Not Attempt Resuscitation\"; and\ninclude the statement \"When not in cardiopulmonary arrest, follow orders in\nB, C, and D.\";\n(b) Section B of the form shall direct the medical interventions when a person has\na pulse or is breathing by selection of one (1) of the following:\n1. Full treatmen t, required if CPR is chosen in Section A, including\nproviding appropriate medical and surgical treatments as indicated to\nattempt to prolong life, including intensive care. This option shall\ninclude the statement \"Goal: Attempt to sustain life by all medi cally\neffective means.\";\n2. Limited additional intervention, which may include use of non -invasive\npositive airway pressure, antibiotics, and IV fluids as indicated, and\nrequires avoidance of intensive care and transfer to a hospital if\ntreatment needs cannot be met in the current location. This option shall\ninclude the statement \"Goal: Attempt to restore function while avoiding\nintensive care and resuscitation efforts (ventilator, defibrillation, and\ncardioversion).\"; or\n3. Comfort measures, including use of oxygen, suction, and manual\ntreatment of airway obstruction as needed for comfort, avoidance of\ntreatments listed in full or limited additional interventions and transfer to\na hospital only if comfort cannot be achieved in the current setting. This\noption shall include the statement \"Goal: Maximize comfort through\nsymptom management; allow natural death.\";\n(c) Section C of the form shall direct the use of artificially administered fluids\nand nutrition, including always offering food and fluids by mouth as tolerated,\nand shall include a statement that medically assisted nutrition and hydration\nwhen it cannot reasonably be expected to prolong life, would be more\nburdensome than beneficial, or would cause significant physical discomfort.\nThe following options shall be provided:\n1. No artificial nutrition by tube;\n2. Trial period of artificial nutrition by tube. This option shall be followed\nby: \"Goal.................\"; or\n3. Long-term artificial nutrition and hydration by tube;\n(d) Section D of the form shall direct the use of antibiotics. The following options\nshall be provided:\n1. Use of antibiotics as medically indicated; or\n2. No antibiotics;\n(e) A section of the form shall provide space to include any additional treatment\npreferences;\n(f) A section of the  form shall be titled \"Attestation by a Licensed Health Care\nProfessional\" and shall include:\n1. Space for the printed name and the signature of the licensed health care\nprofessional and the date of completion; and\n2. A statement that in completing the for m the licensed health care\nprofessional is attesting that:\na. He or she has reviewed the patient's pre -existing advance directive\nand found it in accordance with the selections on the MOST form;\nor\nb. The patient does not have a pre-existing advance directive;\n(g) A section of the form shall be titled \"Signature: Patient or Patient\nRepresentative (E-Signed Documents Are Valid)\" and shall include:\n1. The printed name, signature, and contact telephone number of the\npatient, surrogate, or responsible party;\n2. An indication that the signing party is the:\na. Adult patient with decisional capacity;\nb. Surrogate decision maker per advance directive; or\nc. Responsible party in accordance with KRS 311.631; and\n3. The following statements:\na. \"I agree that adequate information has been provided and\nsignificant thought has been given to decisions outlined in this\nform. Treatment preferences have been expressed to the physician.\nThis document reflects those treatment preferences and indicates\ninformed consent. If signed by a surrogate or responsible party, the\npreferences expressed reflect the patient's wishes as best\nunderstood by that surrogate or responsible party.\"; and\nb. \"Your signature is not required on this form to receive treatment.\";\n(h) A section of the form shall be titled \"Physician Signature (E -Signed\nDocuments Are Valid)\" and shall include:\n1. Space for the physician's printed name, signature, contact telephone\nnumber, and the effective date; and\n2. The following statement: \"My sign ature below indicates that I or my\ndesignee have discussed with the patient, the patient's surrogate, or the\nresponsible party, the patient's goals and available treatment options\nbased on the patient's medical conditions. My signature below indicates\nto the best of my knowledge, that these orders indicated on this form are\nconsistent with the patient's current medical condition and preferences.\";\n(i) A section of the form shall be titled \"Information for Patient, Surrogate, or\nResponsible Party Named on This Form\" with the following language:\n1. \"The MOST form is always voluntary and is usually for persons with\nadvanced illness. MOST records your wishes for medical treatment in\nyour current state of health. The provision of nutrition and fluids, even if\nmedically administered, is a basic human right and authorization to deny\nor withdraw shall be limited to the patient, the surrogate in accordance\nwith KRS 311.629, or the responsible party in accordance with KRS\n311.631.\";\n2. \"KRS 311.631: Responsible parties  authorized to make health care\ndecisions: (1) The judicially appointed guardian of the patient; (2) The\nhealth care power of attorney; (3) The spouse of the patient; (4) An adult\nchild of the patient, or if the patient has more than one child, the\nmajority of the adult children who are reasonably available for\nconsultation; (5) The parents of the patient; (6) The nearest living\nrelative of the patient, or if more than one relative of the same relation is\nreasonably available for consultation, a majority of  the nearest living\nrelatives.\"; and\n3. \"Once initial medical treatment is begun and the risks and benefits of\nfurther therapy are clear, your treatment wishes may change. Your\nmedical care and this form can be changed to reflect your new wishes at\nany tim e. However, no form can address all the medical treatment\ndecisions that may need to be made. An advance directive, such as the\nKentucky Health Care Power of Attorney, is recommended for all\ncapable adults, regardless of their health status. An advance dir ective\nallows you to document in detail your future health care instructions or\nname a surrogate to speak for you if you are unable to speak for\nyourself, or both. If there are conflicting directions between an\nenforceable living will and a MOST form, the provisions of the living\nwill shall prevail.\";\n(j) A section of the form shall be titled \"Directions for Completing and\nImplementing Form\" with these four (4) subdivisions:\n1. The first subdivision shall be titled \"Completing MOST\" and shall have\nthe following language:\n\"MOST must be reviewed and signed by the patient's physician.\nMOST must be reviewed and contain the original signature of the\npatient's physician to be valid. Be sure to document the basis in the\nprogress notes of the medical record. Mode of communication (e.g., in\nperson, by telephone, etc.) should also be documented.\nThe signature of the patient, surrogate, or a responsible party is required;\nhowever, if the patient's surrogate or a responsible party is not\nreasonably available to sign t he original form, a copy of the completed\nform with the signature or electronic signature of the patient's surrogate\nor a responsible party must be signed by the patient's physician and\nplaced in the medical record.\nCopies of the original form are equally as valid as the original form.\nThere is no requirement that a patient have a MOST.\";\n2. The second subdivision shall be titled \"Implementing MOST\" and shall\nhave the following language: \"If a health care provider or facility cannot\ncomply with the orders  due to policy or personal ethics, the provider or\nfacility must arrange for transfer of the patient to another provider or\nfacility.\";\n3. The third subdivision shall be titled \"Reviewing MOST\" and shall have\nthe following language:\n\"This MOST must be rev iewed at least annually, at any time the patient\nor patient's representative requests, and when:\nThe patient is admitted and/or discharged from a health care facility;\nThere is a substantial change in the patient's health status; or\nThe patient's treatment preferences change.\nIf MOST is revised or becomes invalid, draw a line through Sections A -\nD and write \"VOID\" in large letters.\"; and\n4. The fourth subdivision shall be titled \"Revocation of MOST\" and shall\nhave the following language: \"This MOST may b e revoked by the\npatient or the responsible party.\"; and\n(k) A section of the form shall be titled \"Review of MOST\" and shall have the\nfollowing columns and a number of rows as determined by the Kentucky\nBoard of Medical Licensure:\n1. \"Review Date\";\n2. \"Reviewer (print)\";\n3. \"Physician Signature\";\n4. \"Signature of Patient, Surrogate, or Responsible Party\"; and\n5. \"Outcome of Review, describing the outcome in each row by selecting\none (1) of the following:\na. No Change; or\nb. FORM VOIDED\".\n(3) The Kentucky Board of Medical Licensure shall promulgate administrative\nregulations in accordance with KRS Chapter 13A to develop:\n(a) The format for a standardized medical order for scope of treatment form to be\napproved by the board, including spacing, size, borders, fill and location of\nboxes, type of fonts used and their size, and placement of boxes on the front\nor back of the form so as to fit on a single sheet. The board shall create an\nelectronically fillable version of the MOST form that can be accessed on the\nboard's website. The board may not alter the wording or order of wording\nprovided in subsection (1) or (2) of th is section, except to provide translated\nversions of the MOST form or add identifying data such as form number and\ndate of promulgation or revision and instructions for completing, reviewing,\nand revoking the election of the form; and\n(b) A guide to advanc e care planning that describes the following three (3)\noptions for advance care planning:\n1. An advance directive as defined in KRS 311.621;\n2. A power of attorney including advance health care instructions; and\n3. A medical order for scope of treatment.\n(4) The board shall:\n(a) Provide a translation of the MOST form in print and in an electronically\nfillable version into Spanish, and other languages as needed;\n(b) Provide a translation of the guide to advance care planning into Spanish, and\nother languages as needed; and\n(c) Make the MOST form and the guide to advance care planning accessible on\nits website.\n(5) The board shall consult with appropriate professional organizations to develop the\nformat for the medical order for scope of treatment form and the  guide to advance\ncare planning, including:\n(a) The Kentucky Association of Hospice and Palliative Care;\n(b) The Kentucky Board of Emergency Medical Services;\n(c) The Kentucky Hospital Association;\n(d) The Kentucky Association of Health Care Facilities;\n(e) LeadingAge Kentucky;\n(f) The Kentucky Right to Life Association; and\n(g) Other groups interested in end-of-life care.\n(6) The MOST form may be electronic or printed on any color of paper and the form\nshall be honored on any color of paper.\n(7) Health care professionals are encouraged to provide a copy of the guide to advance\ncare planning to the patient, surrogate, or responsible party at the time a MOST\nform is being completed.","path":["KRS Chapter 311"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=55380","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:58:05Z","sha256":"5ad7286383de952f78d859108cbef40c27041f8faf8892d9a4d7f4a71cc55179","source_id":"us-ky","stale":false,"prev":"us-ky/krs-311.622","next":"us-ky/krs-311.623"},"notice":"GroundRules: Original legal text. Not legal advice."}