Colorado MOST

Medical Orders for Scope of Treatment

Hosted by the Center for Bioethics and Humanities

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The Colorado MOST (Medical Orders for Scope of Treatment) form is part of the National POLST Program (Portable Orders for Life-Sustaining Treatment), which promotes standardized, patient-directed medical orders across the United States. The Center for Bioethics and Humanities at the University of Colorado School of Medicine is pleased to be Colorado MOST's administrative home as of summer 2025.

The MOST process helps ensure that care aligns with a patient’s values and goals, even in urgent or complex medical situations. It empowers patients and their care teams to make informed, values-based decisions that are respected throughout the healthcare system.

MOST is intended for patients with serious, life-limiting conditions, including advanced frailty, who are at risk for life-threatening clinical events. It documents a patient’s treatment preferences as medical orders, helping guide care across all settings. Completing a MOST form is entirely voluntary. Under Colorado law (C.R.S. 15-18.7-108), no healthcare facility may require a patient to complete one as a condition of admission or treatment.

MOST forms are portable and must be honored in any care setting — hospital, clinic, long-term care, hospice, or home. While the original is often printed on brightly colored paper for visibility, copies (faxed, scanned, or photocopied) are also valid. The form is completed through a conversation between a healthcare professional and the patient or their authorized healthcare agent. It must be signed by the patient/agent and a physician, advanced practice nurse (APN), or physician assistant (PA), whose signature makes the preferences legally actionable.

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FREQUENTLY ASKED QUESTIONS

No, the MOST is not an advance directive. It is a medical order set that covers only a few of the many issues addressed in advance directives. If a patient has existing directives (e.g., living will, MDPOA), the healthcare professional completing the MOST should review them to ensure consistency—or revise/revoke them to reflect current preferences documented on the MOST.

If no advance directives exist, the MOST still covers key life-sustaining treatment decisions and allows space for additional orders. However, it cannot appoint a healthcare agent or address personal or non-medical matters.

The MOST may serve as a CPR directive, but standalone CPR directives remain valid. Until all EMS and emergency departments are fully familiar with the MOST, it’s wise for patients to carry both. Some long-term care facilities may also require a facility-specific CPR directive; using both is acceptable as long as instructions do not conflict.

It is essential, before completing a MOST, to ask the patient about previously completed advance directives to make sure the documents do not conflict.

The general rule of thumb is that in cases of conflict between a MOST and other advance directives, the most recent document rules. However, there are some nuances to this, depending on who has completed which document when:

The MOST and CPR directives: If a person completed a CPR directive (refusing CPR) before completing a MOST, but then on the MOST says “Yes” to CPR; the most recent document prevails. If the person completed a CPR directive (refusing CPR), and later is incapacitated and the MOST is completed by the person’s Healthcare Agent choosing “Yes CPR,” the prior CPR directive prevails: Healthcare Agents cannot revoke or overrule a CPR directive completed by a competent patient.
The MOST and living wills: A Healthcare Agent cannot complete a living will for an incapacitated patient. Likewise, a Healthcare Agent cannot override or revoke the person’s living will unless specific authority to do so is stated in the living will or the MDPOA document. If the Healthcare Agent completes a MOST for the person and a previously completed living will contradicts any of the MOST provisions, the living will prevails. If the patient completes a MOST for him/herself and a previously completed living will contradicts the MOST, the MOST prevails.

Other states use documents such as the MOST, MOLST, POST or POLST forms. If a patient brings in a form from another state that doesn’t exactly comply with Colorado requirements, the MOST statute says that forms from other states must be honored, subject to the exceptions/limitations in Colorado’s law.

Guía de formularios MOST en español: The Spanish-language guide to the MOST form may be used to facilitate discussion; however, the official MOST form, signed by physician/APN/PA and patient or patient’s authorized decision maker MUST be the two-sided, English-language form. The Spanish version is not an actionable medical order; it is only to be used to help discuss choices.

Se puede usar una versión en español del anverso del formulario para facilitar la discusión; sin embargo, el formulario oficial MOST, firmado por el médico/enfermero practicante/asistente médico y el paciente o su persona autorizada para tomar decisiones, DEBE ser el formulario de dos caras en inglés. La versión en español no constituye una orden médica procesable; solo debe usarse para facilitar la discusión de opciones.