Advanced Care Planning

Advanced Care Planning / Living Will / Maryland Order for Life Sustaining Treatments (MOLST) Form

Do you have questions about Advanced Care Planning? Your team of providers at the Natesan Medical Group are here to assist you with answering your questions and completing these necessary documents.
Did you know that you do not need a lawyer or notary to fill out an Advance Directive?
Did you know that once we have your documents on file in our office, if you are admitted to a Tidal Health facility, then the medical staff would have immediate access to your Advance Directives.
During your Medicare Annual Wellness Visit, we have an opportunity to discuss Advance Care Planning; however, we encourage you to take advantage of scheduling an appointment anytime to discuss and review these topics in further detail. We will be able to help you to discern what matters most to you in the last phase of your life.

What is an Advanced Directive?

An Advanced Directive documents your wishes by delegating up to three people who can make healthcare decisions on your behalf when you are unable to speak for yourself. You may have a primary agent, and two back up decision makers. The Advance Directive is a witnessed document by two people who are not listed as agents, and who will not receive financial benefit from your passing (neighbors, friends, etc). You will choose when your agent has the ability to make decisions for you – either immediately upon signing the document or, when two physicians have certified that you have permanently lost the ability to make your own decisions. Remember this document is only used when you are unable to speak for yourself.

What is the Living Will?

The Living Will is a complementary document to the Advanced Directive, that again requires the same witnessing as the Advanced Directive. This document is intended to guide your care under certain conditions – terminal illness, persistent vegetative state, and end-stage condition.

Why are Advanced Directives and Living Wills important to have?

These documents are important should you ever become seriously ill or injured, and are unable to make a decision for yourself regarding your medical care. Whether it is basic treatment, or up through life sustaining measures, you should have someone identified that you trust to represent your wishes when agreeing to or declining treatment.

Advanced Care Planning allows you to be cared for the way YOU WANT TO BE CARED FOR!

We want to make sure you have the care and quality of life you desire while reducing suffering for you and your loved ones. These documents will reduce the stress on loved ones having to make decisions about your care when you are unable to speak for yourself.

What is the MOLST form?

The MOLST Form – The Maryland Order for Life Sustaining Treatment. This document represents you for the here and the now, until it is reviewed/revised by you and a qualified medical provider (Physician, Nurse Practitioner, or Physician Assistant). This carries your medical decision making until a condition has rendered your Living Will to be enacted. The first page is for Emergency Medical Service providers, but also applicable if you were to be in any health care setting or even the community. If you do not want CPR – YOU NEED A MOLST FORM! If the patient does not have capacity to make the decision and they do not have a health care agent, it will fall to the hierarchy of surrogate decision makers per the Health Care Decisions Act. Remember, the MOLST form can be updated at any point in time depending upon your current health status and/or goals of care for your life.

Who is allowed to decide my medical decisions for me?

There is a level of decision making from “surrogates” (court appointment guardian, spouse, living adult children, parents, adult siblings, and lastly any other family members and friends). Everyone has a unique situation of who is involved in his or her lives and whom they would prefer to make decisions on their behalf. Some decisions require only consent, other decisions; particularly those regarding life-sustaining measures may be more complex. It is important that you make your decisions known and have them documented.
Your designated health care agent will have the ability to speak on your behalf now; or if it is your preference, when two doctors agree that your condition is permanent.

2021 Annotated Code of Maryland Health General Article
Subtitle 6: Health Care Decisions Act Definitions

1. Terminal condition – an incurable condition caused by injury, disease, or illness which, to a reasonable degree of medical certainty, makes death imminent and from which, despite the application of life-sustaining procedures, there can be no recovery.
2. End-Stage Condition – an advanced, progressive, irreversible condition caused by injury, disease, or illness, which has caused severe and permanent deterioration indicated by incompetency and complete physical dependency, and to a reasonable degree of medical certainty, treatment of the irreversible condition would be medically ineffective.
3. Persistent Vegetative State – a condition caused by injury, disease, or illness (patient has had loss of consciousness, without showing behavioral evidence of self-awareness or awareness of surroundings in a learned manner other than reflex activity of muscles and nerves for low-level conditioned response; and after a passage of a medically appropriate period of time, it can be determined, to a reasonable degree of medical certainty, that there can be no recovery.


Maryland Attorney General – Health Care Decisions Act
Maryland Advanced Care Planning