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Medical Order for Life-Sustaining Treatment (MOLST) - DOH[removed]
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Document Date: 2013-11-15 12:55:13

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City

Hospital / /

IndustryTerm

care services / liquid food / food / /

MedicalCondition

pain / airway obstruction / electric shock / infection / shortness of breath / infections / developmental disability / /

MedicalTreatment

Resuscitation / CPR / catheter / dialysis / mechanical ventilation / Antibiotics / /

Organization

NEW YORK STATE DEPARTMENT / Physician’s Office / /

Person

Minor / /

Position

PHYSICIAN / PRINT PHYSICIAN / This MOLST Form The physician / Surrogate Physician / PHYSICIAN SIGNATURE PRINT PHYSICIAN NAME PHYSICIAN LICENSE NUMBER PHYSICIAN / /

ProvinceOrState

New Hampshire / /

Technology

dialysis / /

SocialTag