Re: Formfinder Professional
Nadia Grubb
Honoring patient preferences is a critical element in providing quality end-of-life care. To help physicians and other health care providers discuss and convey a patient's wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatment, the Department of Health has approved form (DOH-5003), Medical Orders for Life-Sustaining Treatment (MOLST), which can be used statewide by health care practitioners and facilities. MOLST is intended for patients with serious health conditions who:
Completion of the MOLST begins with a conversation or a series of conversations between the patient, the patient's health care agent or surrogate, and a qualified, trained health care professional that defines the patient's goals for care, reviews possible treatment options on the entire MOLST form, and ensures shared, informed medical decision-making. Although the conversation(s) about goals and treatment options may be initiated by any qualified and trained health care professional, a licensed physician, nurse practitioner, or physician assistant must always, at a minimum: (i) confer with the patient and/or the patient's health care agent or surrogate about the patient's diagnosis, prognosis, goals for care, treatment preferences, and consent by the appropriate decision-maker, and (ii) sign the orders derived from that discussion.
In hospitals, hospice and nursing homes, the form may be used to issue any orders concerning life-sustaining treatment. In the community, the form may be used to issue nonhospital Do Not Resuscitate (DNR) and Do Not Intubate (DNI) orders, and in certain circumstances, orders concerning other life-sustaining treatment. The signed MOLST form should be transported with patients as they travel to different health care settings. The medical orders on the form need not be re-issued by the patient's new health care provider, but should be reviewed and may be revised by a physician, nurse practitioner, or physician assistant, when the patient transitions to a different setting and when the patient's preferences and/or medical conditions change.
In addition to the MOLST form itself, the Department has developed legal requirements checklists and frequently asked questions. These checklists are NOT intended for use with patients with developmental disabilities who lack medical decision-making capacity, or patients with mental illness in a mental hygiene facility. The checklists are intended to assist providers in satisfying the complex legal requirements associated with decisions concerning life-sustaining treatment for all other patients. They are guidance documents, and the use of these checklists is not mandatory. However, providers that do not use the checklists must use an alternative method for assuring that they adhere strictly to all legal requirements for completing the form, including requirements related to securing informed consent to the medical orders from the proper person, making the clinical judgments necessary to support orders withholding or withdrawing life sustaining treatment and, where applicable, securing ethics committee approval and witnesses to the consent.
The MOLST form has been approved by the Office of Mental Health (OMH) and the Office for People with Developmental Disabilities (OPWDD) for use as a nonhospital DNR/DNI form for persons with developmental disabilities or persons with mental illness, including persons who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act. Please note: The OPWDD has approved a NEW checklist. This checklist MUST be attached to the MOLST form, in order for the form to be used for persons with developmental disabilities who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act. The New OPWDD checklist can be found here. A checklist for persons with mental illness in mental hygiene facilities, who are incapable of making their own health care decisions or who have a guardian of the person appointed pursuant to Article 81 of the Mental Hygiene Law or Article 17-A of the Surrogate's Court Procedure Act, is under development.
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Physicians may bill evaluation and management(E/M) services when furnished by a nonphysician practitioner "incident to" his/her professional service. The physician may bill the CPT code that describes the E/M service provided.
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Name of the physician or nonphysician practitioner who performs the initial service and orders the nonphysician service must appear in item 17. Enter the qualifier to the left of the dotted vertical line on item 17 followed by the name. DN= Referring Provider, DK =Ordering Provider, DQ =Supervising Provider
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