PACIO Advance Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-pacio-adi/ and changes regularly. See the Directory of published versions

PMO Guidance

ADI Content Type 3 Document Structure

Content Type 3, are Portable Medical Orders (such as a DNR and/or POLST/MOLST orders). These documents tell other healthcare professionals what the treatment intervention preferences are for a person, and are usually intended to be created when there is an expectation of a limited life-expectancy. Portable medical order documents are authored by practitioners, not patients, and are legal physician orders. They do not document goals, preferences, and priorities that a patient intends to be referenced as guidance when making care decisions but instead focus on medical treatment intervention decisions that already have been made so as to guide treatment interventions.

All doctors, emergency medical professionals, and other healthcare professionals, must follow these portable medical orders as the person moves from one location to another (hospital, care facility, home, etc.), unless another practitioner examines the person, reviews the orders with the person or their healthcare agent, and a decision is reached that changes to the orders are warranted or desired. In an emergency situation, life-sustaining procedures that are normally required of emergency response personnel will be overridden by the contents of portable medical orders.

Depending on the state, portable medical orders may be known by any of the following names:

• MOLST (Medical Orders for Life Sustaining Treatment)
• POLST (Physician Orders for Life Sustaining Treatment)
• MOST (Medical Orders for Scope of Treatment)
• POST (Physician Orders for Scope of Treatment)
• TPOPP (Transportable Physician Orders for Patient Preferences)
• Out-of-hospital Do Not Resuscitate (DNR) Orders
• DNAR (Do Not Attempt Resuscitation) or AND (Allow Natural Death) Orders

Portable medical orders are not advance directives and should not be confused with them:

1. PMOs are treatment orders written by practitioners.
2. Episode-centric obligation and prohibition instructions written by clinicians and practitioners, not people like advance directives are.
3. PMOs are instructions given by the person or their healthcare agent to a practitioner, who then creates legal orders to carry out those treatment decisions.

These are important distinctions to understand.

Structurally, the document structure shares the same ADI header as the PACP document and includes sections specific to the portable medical order (PMO):