I Want to Plan Ahead

My personal data form.

Complete this form with all of your personal data, from bank accounts to insurance plans, to make planning ahead simpler.

What is a MOST form?

The Medical Orders for Scope of Treatment (MOST) form is a physician’s order or medical order that outlines a plan of care respecting the patients’ wishes.

Who uses the MOST form?

A MOST form is primarily intended for patients who have an advanced chronic or progressive illness, a life expectancy is less than one year or want to clearly define their treatment options as the disease progresses.

How is an advance directive different from the MOST form?

Advance directives are legal documents that are advisable for everyone to complete and are not physician orders. A living will and a health care power of attorney are both examples of advance directives. The MOST form does not replace an advance directive, but it provides detailed          information on choices regarding medical care.

Who fills out the MOST form?

The MOST form must be completed and signed by the patient or patient representative along with a health care provider, such as a physician, physician assistant or nurse practitioner.

How long is the MOST form valid?

A MOST form does not have an expiration date but must be reviewed yearly with your health care provider.

When is the MOST form used?

The MOST form is bright pink in color so it can be easily identified in an emergency situation. The MOST form is considered a Portable Medical Order (PMO) and recognized by health care providers. Only the original pink MOST form is valid (no copies) and should be kept in a location to be available at all time.

Download a North Carolina MOST form by clicking here:

North Carolina Medical Orders for Scope of Treatment (MOST) Form

What are advance directives?

Think of advance directives as life on your terms. They are a way of making your voice heard when you can no longer speak. With advance directives you can express how much care you do and do not want at the end of life. They also allow you to name someone to make decisions about your medical treatment if you are unable to make these decisions or choices yourself. Advance directives generally fall into three categories: health care proxy, durable power of attorney and living will.

Legal forms for advanced directives are available at your doctor’s office, hospital, health department and your state’s department on aging. All 50 states and the District of Columbia have laws regarding advance directives. Documents must comply with the laws in your state. A list of the individual state legal requirements for advanced directives is available at www.caringinfo.org. Once you make your decisions, it’s important that you sign and notarize these documents and give copies to your family, caregivers and health care providers.

You can change or cancel advanced directives at any time provided you are considered competent and able to clearly indicate your desires (“of sound mind”) and state laws are followed. These changes or cancellations should also be signed, notarized and copies given to your family and health care providers to ensure they’re aware of the changes.

Preparing for the end of life is often uncomfortable for most people; however, planning ahead can reduce stress and tension for yourself and your loved ones. By completing advance directives, you can predetermine end-of-life decisions in a legally sound way.

Download a North Carolina advance directive with instructions by clicking here:

HPCG Advance Directive

After carefully reviewing and filling out the form, wait to sign and date it until two witnesses and a notary are present.

The advance directive is not for just filling out—it is an opportunity to communicate—so people are also encouraged to talk about their end-of-life wishes with loved ones.

What is health care proxy?

Health care proxy (also known as designation of a health care surrogate) is a legal document allowing you to select any person you choose to make medical decisions for you if you should become temporarily or permanently unable to make those decisions for yourself. Your health care proxy/surrogate has, in essence, the same rights to request or refuse treatment that you would have if you were capable of making and communicating those decisions.

This is different than durable power of attorney. Durable power of attorney allows an individual to make bank transactions, sign Social Security checks, apply for disability or simply write checks to pay bills if you become incapacitated due to a medical condition.

One advantage of having a health care proxy is that they can make medical decisions based on the most up-to-date treatment information.

What is durable power of attorney?

As part of your advance directives you can draft legal documents providing power of attorney to others. Durable power of attorney allows an individual to handle financial or business activities such as bank transactions, signing Social Security checks, applying for disability or writing checks to pay bills if you become incapacitated due to a medical condition.

What is a living will?

A living will is a written document that spells out what types of medical treatment you desire in the future should you become incapable of communicating your wishes.

The term living will can be confusing because it really isn’t a will at all. It doesn’t do things a will does, like transfer property or name guardians for your minor children.

Living wills can be very specific or very general. Most living wills include a statement that in effect says, “If I suffer an incurable, irreversible illness, disease or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.

Living wills can include more specific information in regard to your desire for such services, such as analgesia (pain relief), antibiotics, hydration, feeding and the use of ventilators or cardiopulmonary resuscitation.

Each state has its own laws about living wills including how they are to be prepared, when they go into effect or how your instructions will be applied. Some states require living wills to be witnessed, some states have a standard form that is recommended and some require it to be signed before a notary.

Without a living will someone else will make medical treatment decisions for you if you should become incapacitated.