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The 411 on Health Care Proxies and MOLST Forms

We ask that participants at Evergreen Adult Day Health Center have a Health Care Proxy form and a MOLST Form on file. This is to make sure that in case of an emergency there are structures in place to ensure everything runs as smoothly as possible. Below is an explanation of the two forms.

Health Care Proxy:

A health care proxy is a legal document that names someone you trust as your proxy, or agent, to express your wishes and make health care decisions for you in case you are unable to make them for yourself. You do not have to be terminally ill to designate a health care proxy or for that proxy to make decisions on your behalf. They will make treatment decisions whenever you are incapacitated and unable to communicate due to temporary or permanent illness or injury. In fact it is very important when possible to assign a health care proxy when you are healthy and able to both express your wishes

and make sure that your proxy both understands and is willing to make decisions based on your wishes on your behalf. You have the right to change your proxy at any time by simply filling out a new proxy document. The proxy document also allows you to name a backup agent. This is important to name just in case the primary agent is unable to carry out the duties.


The MOLST form is a pink medical document that needs to be discussed with your doctor and family members. It needs to be signed off by a doctor. This document outlines your wishes regarding life sustaining measures you wish to be used in case you need them. In the discussion with your doctor and family member the doctor will explain what each element means and then you and your family member can make a decision that is best for you.

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