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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsSeptember 2017

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16 DE Admin. Code 4304
On April 1, 2017 (Volume 20, Issue 10), DHSS published in the Delaware Register of Regulations its notice of proposed regulations, pursuant to 29 Delaware Code Section 10115. It requested that written materials and suggestions from the public concerning the proposed regulations be delivered to DHSS by May 4, 2017, after which time the DHSS would review information, factual evidence and public comment to the said proposed regulations.
These DMOST regulations implement 16 Del.C. Ch. 25A which authorizes the Division of Public Health/Office of Emergency Medical Services, in conjunction with the Board of Medical Licensure and Discipline, the Delaware EMS Oversight Council, the Delaware State Fire Prevention Commission, and other key groups within the State to develop and implement DMOST regulations and protocol. These regulations, protocol, and form standardize documentation so that Emergency Medical Service (EMS) personnel and all health care providers have a readily recognizable form which sets forth a patient’s preferences regarding the provision of and the scope of treatment. The DMOST form allows EMS personnel and other health care providers both to identify and to honor an individual’s wishes to the greatest extent possible and to grant individuals the dignity, humanity, and compassion they deserve.
"Advance Health-Care Directive (AHCD)” means an Advance Health-Care Directive under 16 Del.C. Ch. 25, a durable power of attorney for health care decisions, or any individual instruction or power of attorney for health care valid under Delaware law because it is valid in the state where such document was executed or where the individual executing such document was a resident at the time that such document appointing an agent was executed. Said document must have been executed by the individual authorizing the appointed agent to make decisions about the individual's health care when such individual no longer has decision-making capacity.
Decision-making capacity” means a patient's ability to understand and appreciate the nature and consequences of a particular health care decision, including the benefits and risks of that decision and alternatives to any proposed health care treatment, and to reach an informed health care decision.
Delaware Medical Orders for Scope of Treatment (DMOST)” means a clinical process to facilitate communication between health care professionals and a patient living with serious illness or frailty whose health care practitioner would not be surprised if the patient died within the next year or, if the patient lacks decision-making capacity, the patient’s authorized representative. The process encourages shared, informed medical decision-making. The decisions are memorialized on a completed DMOST form, which contains portable medical orders that respect the patient’s goals for care with respect to the use of CPR and other life-sustaining treatments and medical interventions. The DMOST form is applicable across health care settings, is reviewable, and the patient controls if it can be voided.
Department” means the Department of Health and Social Services.
DMOST form” means the standardized document created by the Department that is identified as an Attachment to these regulations, which:
Emergency-care provider” means an emergency medical technician, paramedic, or first responder authorized under 16 Del.C. Ch 97.
Health care institution” means an institution, facility, or agency licensed, certified or otherwise authorized or permitted by law to provide health care in the ordinary course of business.
Health care practitioner” means a physician or an individual licensed and authorized to write medical orders pursuant to 24 Del.C. Ch. 17 and Ch. 19 who is providing care for the patient or overseeing the health care provided to the patient and has completed all training required by the Department for individuals participating in the completion of a DMOST form. Over time, a patient’s health care practitioner may change.
Health care provider” means an individual licensed, certified, or otherwise authorized or permitted by law to provide health care in the ordinary course of business or practice of a profession. A health care practitioner is also a health care provider.
Life-sustaining treatment” includes any medical intervention, including procedures, administration of medication, or use of a medical device, that maintains life by sustaining, restoring, or supplanting a vital function. It does not include care provided for the purpose of keeping a patient comfortable.
Patient” means an individual who is under the care of the health care practitioner or health care provider.
Patient’s authorized representative” or “authorized representative” means the individual signing a DMOST form on behalf of a patient without decision-making capacity, who has the highest priority to act for the patient under law, and who has the authority to make decisions with respect to the patient’s health care preferences being made on the DMOST form. The health care practitioner shall determine the individual who is the patient’s authorized representative by referencing the documentation giving such individual the required authority under law. Based on the documentation provided by such individual as evidence of his or her authority, the patient’s authorized representative could be an individual designated by a patient under an advance health-care directive, an agent under a medical durable power of attorney for health care decisions, a guardian of the person appointed pursuant to 12 Del.C. Ch. 39 or Ch. 39A, in accordance with the authority granted by the appointing court, a surrogate appointed under 16 Del.C. Ch. 25, or an individual who is otherwise authorized under applicable law to make the health care decisions being made by execution of the DMOST form on the patient’s behalf, if the patient lacks decision-making capacity.
Scope of treatment” means those medical interventions, procedures, medications, and treatments that a patient, in consultation with a health care practitioner, has determined are appropriate, necessary, and desired by and for the patient and will always include the provision of comfort measures. A patient may decline life-sustaining treatment.
Serious illness or frailty” means a condition for which a health care practitioner would not be surprised if a patient died within the next year.
2.1.1 The patient’s identification block has the patient’s name (last, first, middle), patient's address of record, patient's phone number, patient's gender, patient's date of birth, and last four digits of the patient’s social security number.
4.9.2.3 If the there is no Guardian or Agent or if the designated Guardian or Agent is unavailable, or if the patient revoked an Advance Health-Care Directive pursuant to 16 Del.C. §2504, the Surrogate Statute applies and will allow either the individual named by the patient prior to losing decision-making capacity or if none, the individual recognized by the Surrogate Statute, 16 Del.C. §2507, to make decisions with respect to the patient's health care preferences being made on the DMOST form on behalf of the patient.
Q. What is DMOST?
A. The Delaware Medical Orders for Scope of Treatment (DMOST) form is a portable medical order form. It allows you to make choices about life-sustaining treatments, including among other treatments, CPR (resuscitation) and artificial nutrition. You may request full treatment, limited treatment, or comfort care only.
Q. Who is it for?
A. A DMOST form can be used by a person with a serious illness or frailty, whose health care practitioner would not be surprised if the person died within the next year.
Q. When should it be discussed and signed? Who signs it?
A. A DMOST form is completed after a conversation you have with a health care practitioner. It is signed by you and a physician (MD or DO), an advanced practice registered nurse (APRN), or a physician assistant (PA). The physician/APRN/PA signature makes the choices into portable medical orders.
Q. Can someone else make DMOST decisions for me?
A. You make health care decisions for yourself as long as you have decision-making capacity. You have the right to change your authorized representative at any time while you have decision-making capacity.
Q. What if I change my mind?
A. If your condition or your choices change, you or your authorized representative should void (cancel) your DMOST form and request a new DMOST be completed with your new choices. You can void a DMOST form if you change your mind but do not want to create a new one. You may not make any changes to the content of the DMOST form. If you want to change your DMOST form you must void your previous form and complete a new one with your health care practitioner. If your DMOST form does not agree with your advance directive, the most recent document will be followed.
Q. Must I do this?
A. The DMOST form is always voluntary and can be voided at any time. A health care organization is prohibited from requiring you to complete a DMOST form for any reason, including as part of a person’s admission to a health care facility.
Q. What will happen to my choices if I travel out of state?
A. Many states, including all the states in our region, currently use a form similar to the DMOST form. Forms from those states which are valid under the Delaware law will be honored in Delaware. DMOST forms will be honored in other states which have reciprocity.
Last Updated: December 31 1969 19:00:00.
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