Posted over 1 year ago by Robin Arends


Effective on July 1, 2019, medical providers in South Dakota and their patients who have been diagnosed with a terminal illness will be able to translate their treatment goals and preferences into actionable medical orders, known as MOST.  

 On March 27, 2019 Governor Noem signed into law Senate bill 118 to establish certain provisions regarding advance care planning and allow the execution of a medical order based on a standardized form which is transportable across all healthcare settings and in all facilities. The purpose of the MOST form is to ensure all individuals who are facing a terminal condition have been given the opportunity to discuss their condition with their medical provider and have had the opportunity to express their values and preferences for life-sustaining treatment documented in a medial order.  

 South Dakota MOST does not replace an advance healthcare directive (durable power of attorney for healthcare or living will). Both documents work together in a patient-centered approach to honor the values, wishes and goals of each patient.  

 Here are a few things to note regarding South Dakota MOST:

 1.   MOST is 100% voluntary and only to be used when a patient has been diagnosed with a terminal illness whose life expectancy is less than one year.  

 2.   MOST does not replace Comfort One (DNR order). Comfort One tells emergency personnel that the patient does not want to be resuscitated. A MOST is for patients with a terminal illness and includes options to receive other types and levels of treatment. 

 3.   The MOST form is only available on the South Dakota Department of Health website. Medical facilities who wish to keep hard copies of the form for patients must print copies of the form off of the SD DOH website.  

 4.   The official training documents, along with many other resources for MOST, are available on the South Dakota Association of Healthcare Organization (SDAHO) website under Education / MOST. In order to maintain the integrity and consistency of information being shared with patients and providers in South Dakota, the material must not be altered. 

 5.   A MOST form includes a series of medical orders; therefore, it must be saved in the patient’s medical record. A copy of the MOST form shall be given to the patient to save and share with their family and authorized representative.  

 Please take a moment to access the training material at

 You will notice several resources that are available to you, including: 

 Documents: FAQ sheet, link to the MOST form, link to the MOST legislation, a MOST policy template for your facility to customize based on your EMR/medical records policies and procedures.  

 Training: Comprehensive power point presentation, a draft training agenda, video testimonials and an additional training documentary which displays the emotions and decisions that doctors, patients and families must make during end-of-life situations.  

 Resources: This section includes links to national and state resources who played a role in creating and passing the MOST legislation.  

 If you have questions or comments regarding the training material, contact Tammy Hatting at or 605-361-2281.  

 Special thanks to members of the LifeCircle group who were integral in developing and supporting the MOST initiative to promote advance care planning conversations between patients and providers.