To amend sections 2133.21, 2133.22, 2133.23, 2133.24, and 2133.26, to enact sections 2133.212 and 2133.30 to 2133.48, and to repeal section 2133.25 of the Revised Code to require the Director of Health to prescribe a form to document medical orders for life-sustaining treatment and to make changes to the law governing DNR identification and orders.

Section 1. That sections 2133.21, 2133.22, 2133.23, 2133.24, and 2133.26 be amended and sections 2133.212, 2133.30, 2133.31, 2133.32, 2133.33, 2133.34, 2133.35, 2133.36, 2133.37, 2133.38, 2133.39, 2133.40, 2133.41, 2133.42, 2133.43, 2133.44, 2133.45, 2133.46, 2133.47, and 2133.48 of the Revised Code be enacted to read as follows:

Sec. 2133.21.  As used in this section and sections 2133.21 to 2133.211, 2133.22, 2133.24, and 2133.26 of the Revised Code, unless the context clearly requires otherwise:

(A) "Attending physician" means the physician to whom a person, or the family of a person, has assigned primary responsibility for the treatment or care of the person or, if the person or the person's family has not assigned that responsibility, the physician who has accepted that responsibility.

(B) "CPR" means cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, but it does not include clearing a person's airway for a purpose other than as a component of CPR.

(C) "Declaration," "health care facility," "life-sustaining treatment," "physician," "professional disciplinary action," and "tort action" have the same meanings as in section 2133.01 of the Revised Code means a document executed in accordance with section 2133.02 of the Revised Code that includes a specific authorization for the use or continuation, or the withholding or withdrawal, of CPR.

(C)(D) "DNR identification" means a standardized identification card, form, necklace, or bracelet that is of uniform size and design, that has been approved by the department of health pursuant to section 2133.25 of the Revised Code, and that signifies either one of the following:

(1) That the person who is named on and possesses the card, form, necklace, or bracelet has executed a declaration that authorizes the withholding or withdrawal of CPR and that has not been revoked pursuant to section 2133.04 of the Revised Code;

(2) That the attending physician of the person who is named on and possesses the card, form, necklace, or bracelet has issued a current do-not-resuscitate order, in accordance with the do-not-resuscitate protocol adopted by the department of health pursuant to section 2133.25 of the Revised Code, for that person and has documented the grounds for the order in that person's medical record.;

(3) That an issuing practitioner has completed a MOLST form that has not been superseded as described in section 2133.41 of the Revised Code or revoked as described in section 2133.39 of the Revised Code.

(D)(E) "Do-not-resuscitate order" means a directive, other than a hospital do-not-resuscitate order, issued by a physician prior to the effective date of this amendment that identifies a person and specifies that CPR should not be administered to the person so identified.

(E) "Do-not-resuscitate protocol" means the standardized method of procedure for the withholding of CPR by physicians, emergency medical service personnel, and health care facilities that is adopted in the rules of the department of health pursuant to section 2133.25 of the Revised Code.

(F) "Emergency medical services personnel" means paid or volunteer firefighters, law enforcement officers, first responders, emergency medical technicians-basic, emergency medical technicians-intermediate, emergency medical technicians-paramedic, medical technicians, or other emergency services personnel acting within the ordinary course of their profession.

(G) "CPR" means cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, but it does not include clearing a person's airway for a purpose other than as a component of CPR "Health care facility," "life-sustaining treatment," "physician," "professional disciplinary action," and "tort action" have the same meanings as in section 2133.01 of the Revised Code.

(H) "Hospital do-not-resuscitate order" means a directive issued by a physician pursuant to section 2133.212 of the Revised Code.

(I) "Issuing practitioner" has the same meaning as in section 2133.30 of the Revised Code.

(J) "MOLST form" means a form completed pursuant to division (A) of section 2133.33 of the Revised Code that includes a specific authorization for the use or continuation, or the withholding or withdrawal, of CPR.

Sec. 2133.212. A physician may issue a directive for a person admitted to a hospital that identifies the person and specifies that CPR should not be administered to the person during the relevant hospital stay. A directive issued under this section is valid only for the single hospital stay during which it is made and expires at the time of the patient's discharge from the hospital.

At the time of discharge, the patient's physician or an employee or agent of the hospital shall destroy the directive, inform the patient or the patient's representative of such destruction, and explain that a physician, physician assistant, or advanced practice nurse is permitted under section 2133.33 of the Revised Code to issue medical orders for life-sustaining treatment for the patient by completing a MOLST form.

Sec. 2133.22.  (A)(1) None of the following are subject to criminal prosecution, to liability in damages in a tort or other civil action for injury, death, or loss to person or property, or to professional disciplinary action arising out of or relating to the withholding or withdrawal of CPR from a person who has executed a declaration, for whom a do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed, or after DNR identification is discovered in the person's possession and reasonable efforts have been made to determine that the person in possession of the DNR identification is the person named on the DNR identification:

(a) A physician who causes the withholding or withdrawal of CPR from the person possessing who has executed a declaration, for whom a do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed, or who possesses the DNR identification;

(b) A person who participates under the direction of or with the authorization of a physician in the withholding or withdrawal of CPR from the person possessing who has executed a declaration, for whom a do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed, or who possesses the DNR identification;

(c) Any emergency medical services personnel who cause or participate in the withholding or withdrawal of CPR from the person possessing who has executed a declaration, for whom a do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed, or who possesses the DNR identification.

(2) None of the following are subject to criminal prosecution, to liability in damages in a tort or other civil action for injury, death, or loss to person or property, or to professional disciplinary action arising out of or relating to the withholding or withdrawal of CPR from a person in a health care facility who has executed a declaration, for whom a do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed, or after DNR identification is discovered in the person's possession and reasonable efforts have been made to determine that the person in possession of the DNR identification is the person named on the DNR identification or a do-not-resuscitate order is issued for the person:

(a) The health care facility or the administrator of the health care facility;

(b) A physician who causes the withholding or withdrawal of CPR from the person possessing who has executed a declaration, for whom a do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed, or who possesses the DNR identification or for whom the do-not-resuscitate order has been issued;

(c) Any person who works for the health care facility as an employee, contractor, or volunteer and who participates under the direction of or with the authorization of a physician in the withholding or withdrawal of CPR from the person possessing who has executed a declaration, for whom a do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed, or who possesses the DNR identification;

(d) Any person who works for the health care facility as an employee, contractor, or volunteer and who participates under the direction of or with the authorization of a physician in the withholding or withdrawal of CPR from the person for whom the do-not-resuscitate order has been issued.

(3) If, after DNR identification is discovered in the possession of a person, the person makes an oral or written request to receive CPR, any person who provides CPR pursuant to the request, any health care facility in which CPR is provided, and the administrator of any health care facility in which CPR is provided are not subject to criminal prosecution as a result of the provision of the CPR, are not liable in damages in a tort or other civil action for injury, death, or loss to person or property that arises out of or is related to the provision of the CPR, and are not subject to professional disciplinary action as a result of the provision of the CPR.

(B) Divisions (A)(1), (A)(2), and (C) of this section do not apply when CPR is withheld or withdrawn from a person who has executed a declaration, for whom a do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed, or who possesses DNR identification or for whom a do-not-resuscitate order has been issued unless the withholding or withdrawal is in accordance with the do-not-resuscitate protocol instructions regarding the withholding or withdrawal of CPR in the declaration, do-not-resuscitate order or hospital do-not-resuscitate order, or MOLST form.

(C) Any emergency medical services personnel who comply with a do-not-resuscitate order issued by a physician and any individuals who work for a health care facility as employees, contractors, or volunteers and who comply with a do-not-resuscitate order issued by a physician are not subject to liability in damages in a civil action for injury, death, or loss to person or property that arises out of or is related to compliance with the order, are not subject to criminal prosecution as a result of compliance with the order, and are not subject to professional disciplinary action as a result of compliance with the order.

In an emergency situation, emergency medical services personnel and emergency department personnel are not required to search a person to determine if the person possesses DNR identification. If a person possesses DNR identification, if emergency medical services personnel or emergency department personnel provide CPR to the person in an emergency situation, and if, at that time, the personnel do not know and do not have reasonable cause to believe that the person possesses DNR identification, the emergency medical services personnel and emergency department personnel are not subject to criminal prosecution as a result of the provision of the CPR, are not liable in damages in a tort or other civil action for injury, death, or loss to person or property that arises out of or is related to the provision of the CPR, and are not subject to professional disciplinary action as a result of the provision of the CPR.

(D) Nothing in sections 2133.21 to 2133.26 of the Revised Code or the do-not-resuscitate protocol grants immunity to a physician for issuing a do-not-resuscitate order or hospital do-not-resuscitate order that is contrary to reasonable medical standards or that the physician knows or has reason to know is contrary to the wishes of the patient or of a person who is lawfully authorized to make informed medical decisions on the patient's behalf.

Sec. 2133.23.  (A) If emergency medical services personnel, other than physicians, are presented with DNR identification possessed by a person or are presented with a written do-not-resuscitate order for a person or if a physician directly issues to emergency medical services personnel, other than physicians, an oral do-not-resuscitate order for a person any of the following, the emergency medical services personnel shall comply with the do-not-resuscitate protocol for the person. If an oral do-not-resuscitate order is issued by a physician who is not present at the scene, the emergency medical services personnel shall verify the physician's identity instructions regarding the withholding or withdrawal of CPR in the relevant document:

(1) A declaration executed by the person;

(2) A written do-not-resuscitate order or hospital do-not-resuscitate order that has been issued for the person;

(3) A MOLST form that has been completed for the person.

(B) If a person possesses DNR identification and if the person's attending physician or the health care facility in which the person is located is unwilling or unable to comply with the do-not-resuscitate protocol for the person instructions regarding the withholding or withdrawal of CPR in a declaration executed by the person, a written do-not-resuscitate order or hospital do-not-resuscitate order that has been issued for the person, or a MOLST form that has been completed for the person, the attending physician or the health care facility shall not prevent or attempt to prevent, or unreasonably delay or attempt to delay, the transfer of the person to a different physician who will follow the protocol instructions or to a different health care facility in which the protocol instructions will be followed.

(C) If a person who possesses DNR identification or for whom a current who has executed a declaration or for whom a written do-not-resuscitate order has been issued or MOLST form has been completed is being transferred from one health care facility to another, before or at the time of the transfer, the transferring health care facility shall notify the receiving health care facility and the persons transporting the person of the existence of the DNR identification or the order, declaration, written do-not-resuscitate order, or MOLST form. If a current do-not-resuscitate order was issued orally, it shall be reduced to writing before the time of the transfer. The DNR identification or the order, declaration, written do-not-resuscitate order, or MOLST form shall accompany the person to the receiving health care facility and shall remain in effect unless it is revoked or unless, in the case of a do-not-resuscitate order, the order no longer is current any of the following circumstances apply:

(1) In the case of a DNR identification, it has been revoked.

(2) In the case of a declaration, it has been revoked as described in section 2133.04 of the Revised Code.

(3) In the case of a written do-not-resuscitate order, it is no longer current.

(4) In the case of a MOLST form, it has been superseded as described in section 2133.41 of the Revised Code, revoked as described in section 2133.39 of the Revised Code, or when a condition in division (A) or (B) of section 2133.43 of the Revised Code applies.

Sec. 2133.24.  (A) The death of a person resulting from the withholding or withdrawal of CPR for the person pursuant to the do-not-resuscitate protocol instructions regarding the withholding or withdrawal of CPR in a declaration executed by the person, a written do-not-resuscitate order or hospital do-not-resuscitate order that has been issued for the person, or a MOLST form that has been completed for the person and in the circumstances described in section 2133.22 of the Revised Code or in accordance with division (A) of section 2133.23 of the Revised Code does not constitute for any purpose a suicide, aggravated murder, murder, or any other homicide.

(B)(1) If a person has executed a declaration, or a written do-not-resuscitate order or hospital do-not-resuscitate order has been issued or a MOLST form completed for the person, or the person possesses DNR identification or if a current do-not-resuscitate order has been issued for a person, the existence of the declaration, written do-not-resuscitate order or hospital do-not-resuscitate order, MOLST form, or possession or order of the DNR identification shall not do either of the following:

(a) Affect in any manner the sale, procurement, issuance, or renewal of a policy of life insurance or annuity, notwithstanding any term of a policy or annuity to the contrary;

(b) Be deemed to modify in any manner or invalidate the terms of any policy of life insurance or annuity that is in effect on the effective date of this section.

(2) Notwithstanding any term of a policy of life insurance or annuity to the contrary, the withholding or withdrawal of CPR from a person who is insured or covered under the policy or annuity and who possesses DNR identification or for whom a current do-not-resuscitate order has been issued, in accordance with sections 2133.21 to 2133.26 of the Revised Code, who has executed a declaration, or for whom a written do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed shall not impair or invalidate any policy of life insurance or annuity.

(3) Notwithstanding any term of a policy or plan to the contrary, neither of the following shall impair or invalidate any policy of health insurance or other health care benefit plan:

(a) The withholding or withdrawal in accordance with sections 2133.21 to 2133.26 of the Revised Code of CPR from a person who is insured or covered under the policy or plan and who possesses DNR identification or for whom a current do-not-resuscitate order has been issued, who has executed a declaration, or for whom a written do-not-resuscitate order or hospital do-not-resuscitate order has been issued or MOLST form has been completed;

(b) The provision in accordance with sections 2133.21 to 2133.26 of the Revised Code of CPR to a person of the nature described in division (B)(3)(a) of this section.

(4) No physician, health care facility, other health care provider, person authorized to engage in the business of insurance in this state under Title XXXIX of the Revised Code, health insuring corporation, other health care benefit plan, legal entity that is self-insured and provides benefits to its employees or members, or other person shall require an individual to possess DNR identification, execute a declaration, or have a written do-not-resuscitate order or hospital do-not-resuscitate order issued or MOLST form completed, or shall require an individual to revoke or refrain from possessing DNR identification, as a condition of being insured or of receiving health care benefits or services.

(C)(1) Sections 2133.21 to 2133.26 of the Revised Code do not create any presumption concerning the intent of an individual who does not possess DNR identification with respect to the use, withholding, or withdrawal of CPR.

(2) Sections 2133.21 to 2133.26 of the Revised Code do not affect the right of a person to make informed decisions regarding the use, withholding, or withdrawal of CPR for the person as long as the person is able to make those decisions.

(3) Sections 2133.21 to 2133.26 of the Revised Code are in addition to and independent of, and do not limit, impair, or supersede, any right or responsibility that a person has to effect the withholding or withdrawal of life-sustaining treatment to another pursuant to sections 2133.01 to 2133.15 or sections 2133.30 to 2133.48 of the Revised Code or in any other lawful manner.

(D) Nothing in sections 2133.21 to 2133.26 of the Revised Code condones, authorizes, or approves of mercy killing, assisted suicide, or euthanasia.

Sec. 2133.26.  (A)(1) No physician shall purposely prevent or attempt to prevent, or delay or unreasonably attempt to delay, the transfer of a patient in violation of division (B) of section 2133.23 of the Revised Code.

(2) No person shall purposely conceal, cancel, deface, or obliterate the DNR identification of another person without the consent of the other person.

(3) No person shall purposely falsify or forge a revocation of a declaration or MOLST form that is the basis of the DNR identification of another person or purposely falsify or forge an order of a physician or a MOLST form that purports to supersede a do-not-resuscitate order or hospital do-not-resuscitate order issued, or MOLST form completed, for another person.

(4) No person shall purposely falsify or forge the DNR identification of another person with the intent to cause the use, withholding, or withdrawal of CPR for the other person.

(5) No person who has personal knowledge that another person has revoked a declaration that is the basis of the other person's DNR identification or personal knowledge that a physician has issued an order that supersedes a do-not-resuscitate order that the physician issued for another person None of the following shall purposely conceal or withhold that personal knowledge with the intent to cause the use, withholding, or withdrawal of CPR for the other person:

(a) A person who has personal knowledge that another person has revoked a declaration that is the basis of the other person's DNR identification;

(b) A person who has personal knowledge that a physician has issued an order that supersedes a do-not-resuscitate order or hospital do-not-resuscitate order that the physician issued for another person;

(c) A person who has personal knowledge that another person has revoked or superseded a MOLST form that is the basis of the other person's DNR identification.

(B)(1) Whoever violates division (A)(1) or (5) of this section is guilty of a misdemeanor of the third degree.

(2) Whoever violates division (A)(2), (3), or (4) of this section is guilty of a misdemeanor of the first degree.

Sec. 2133.30. As used in this section and sections 2133.31 to 2133.48 of the Revised Code:

(A) "Advanced practice nurse" means a registered nurse who holds a valid certificate that authorizes the practice of nursing as a certified nurse practitioner or a clinical nurse specialist in accordance with section 4723.43 of the Revised Code.

(B) "Attending physician" means the physician to whom a patient or patient's family has assigned primary responsibility for the medical treatment or care of the patient or, if the responsibility has not been assigned, the physician who has accepted that responsibility.

(C) "Comfort care" means any of the following:

(1) Nutrition when administered to diminish pain or discomfort, but not to postpone death;

(2) Hydration when administered to diminish pain or discomfort, but not to postpone death;

(3) Any other medical or nursing procedure, treatment, intervention, or other measure that is taken to diminish pain or discomfort, but not to postpone death.

(D) "CPR" has the same meaning as in section 2133.21 of the Revised Code.

(E) "Declaration" means a document executed in accordance with section 2133.02 of the Revised Code.

(F) "DNR identification," "do-not-resuscitate order," and "hospital do-not-resuscitate order" have the same meanings as in section 2133.21 of the Revised Code.

(G) "Durable power of attorney for health care" means a document created pursuant to sections 1337.11 to 1337.17 of the Revised Code.

(H) "Emergency medical services worker" means a paid or volunteer firefighter, law enforcement officer, first responder, emergency medical technician-basic, emergency medical technician-intermediate, emergency medical technician-paramedic, medical technician, or other emergency services worker acting within the ordinary course of the emergency services profession.

(I) "Form preparer" means the issuing practitioner who completes a medical orders for life-sustaining treatment form or the individual who completes the form pursuant to the practitioner's delegation.

(J) "Health care facility" has the same meaning as in section 1337.11 of the Revised Code.

(K) "Issuing practitioner" means a physician, physician assistant, or advanced practice nurse who issues medical orders for life-sustaining treatment for a patient by signing as the issuing practitioner the medical orders for life-sustaining treatment form for the patient.

(L) "Life-sustaining treatment" means any medical procedure, treatment, intervention, or other measure that, when administered to a patient, is intended to serve principally to prolong the process of dying.

(M) "Medical orders for life-sustaining treatment" means instructions, issued by a physician, physician assistant, or advanced practice nurse, regarding how a patient should be treated with respect to hospitalization, administration or withdrawal of life-sustaining treatment and comfort care, and other treatment the director of health has specified in rules adopted under section 2133.31 of the Revised Code.

(N) "Medical orders for life-sustaining treatment form," "MOLST form," or "form" means the form prescribed by the director of health pursuant to rules adopted under section 2133.31 of the Revised Code that when completed documents an issuing practitioner's medical orders for life-sustaining treatment.

(O) "Nutrition" means sustenance that is artificially or technologically administered.

(P) "Patient" means an individual eighteen years of age or older who is the subject of a MOLST form.

(Q) "Physician" means an individual authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(R) "Physician assistant" means an individual who holds a valid certificate to practice as a physician assistant issued under Chapter 4730. of the Revised Code.

Sec. 2133.31. (A) Subject to division (D) of this section, the director of health shall adopt rules in accordance with Chapter 119. of the Revised Code to do all of the following:

(1) Specify the treatment, in addition to hospitalization, administration or withdrawal of life-sustaining treatment and comfort care, and administration of CPR that may be included in instructions that constitute medical orders for life-sustaining treatment under section 2133.30 of the Revised Code;

(2) Subject to divisions (B) and (C) of this section, prescribe a medical orders for life-sustaining treatment (MOLST) form;

(3) Specify procedures for a MOLST form to be amended or revoked;

(4) Specify what constitutes full treatment for purposes of section 2133.42 of the Revised Code;

(5) Specify the requirements an individual must meet to be authorized to complete a MOLST form when this responsibility is delegated by an issuing practitioner;

(6) Specify the extent to which medical orders for life-sustaining treatment forms, physician orders for life-sustaining treatment forms, or physician orders for scope of treatment forms executed under the laws or regulations of other states are valid for purposes of sections 2133.31 to 2133.48 of the Revised Code;

(7) Specify the individual or class of individuals who must sign and date a MOLST form if all of the individuals or classes of individuals in divisions (B)(1) to (7) of section 2133.34 of the Revised Code are incapacitated or are not willing to participate or are not available within a reasonable period of time to participate in the completion of a MOLST form;

(8) Address any other matters necessary or appropriate to implement or clarify sections 2133.31 to 2133.48 of the Revised Code.

(B) The rules the director adopts under division (A)(2) of this section must, at minimum, address all of the following:

(1) The color the MOLST form must be if it is on paper;

(2) The logo that identifies a form, whether in paper or electronic format, as an official MOLST form;

(3) The inclusion of a space designated for the patient's name;

(4) The inclusion of spaces designated for the names, telephone numbers, signatures, and dates of signature of all of the following:

(a) The issuing practitioner;

(b) The form preparer;

(c) The patient or individual or class of individuals specified in division (B) of section 2133.34 of the Revised Code who participate in the form's completion.

(5) The inclusion of boxes for the form preparer to indicate whether a physician or advanced practice nurse issued a do-not-resuscitate order for the patient prior to the effective date of this section and whether the patient has executed a declaration or a durable power of attorney for health care.

(6) The inclusion of boxes corresponding to a range of preferences the patient or individual or class of individuals specified in division (B) of section 2133.34 of the Revised Code who participate in a form's completion can select regarding various medical treatments and when such treatments should be administered, including, but not limited to, CPR, antibiotics, artificially or technologically administered nutrition and hydration, and other medical interventions and the inclusion of spaces next to the boxes for the name of the patient, individual, or individuals who make the selections;

(7) The inclusion of a space where the form preparer can indicate whether the patient authorizes another individual to do both of the following:

(a) Make all medical decisions on the patient's behalf, including those regarding the administration of CPR and other life-sustaining treatment;

(b) Revoke the form at any time in accordance with the procedure prescribed in rules adopted under section 2133.31 of the Revised Code and complete a new form.

(8) The inclusion of a space for the form preparer to list the name and contact information for the attorney in fact under the patient's durable power of attorney for health care or, if the patient has not executed a durable power of attorney for health care or the form preparer is not told who the attorney in fact is, the patient's next of kin.

(9) The inclusion of a space designated for the signature of a patient's attorney in fact under a durable power of attorney for health care, to be signed by the attorney in fact if the attorney in fact is present when the form is completed;

(10) The inclusion of a space for the form preparer to indicate the date that the form was completed and signed in accordance with sections 2133.34 and 2133.35 of the Revised Code;

(11) The inclusion of spaces designated for the names of individuals who review the form after it is completed, the dates on which reviews are completed, and the reviewer to indicate the review's outcome;

(12) The inclusion of the following advisory statements, in boldface type:

(a) "There is no requirement that a patient or patient's representative execute a MOLST form. You are not required to sign this form for the patient to receive treatment."

This statement shall appear in the space immediately above the space designated for the signature of the patient or individual or class of individuals specified in division (B) of section 2133.34 of the Revised Code who participate in a form's completion.

(b) "Use of this form is permitted for persons who are at least eighteen years old and have advanced chronic progressive illness, might die within the next year, or desire to define their preferences for medical care."

(c) "The instructions in this form may supersede an inconsistent instruction in a declaration (living will), durable power of attorney for health care, or a DNR identification as described in section 2133.41 of the Ohio Revised Code."

(d) "This form may be revoked in accordance with section 2133.39 of the Ohio Revised Code."

(C) When prescribing a medical orders for life-sustaining treatment form pursuant to division (A)(2) of this section, the director shall consider the design and content of forms used in other states to document medical or physician orders for life-sustaining treatment.

(D) The director shall adopt the initial rules required by this section not later than six months after the effective date of this section.

Sec. 2133.32.  The MOLST form prescribed in rules adopted under section 2133.31 of the Revised Code shall be made available on the department of health's web site in a format that can be downloaded free of charge and reproduced.

Sec. 2133.33.  (A) Except as provided in division (C) of this section, a physician, physician assistant, or advanced practice nurse may at any time issue medical orders for life-sustaining treatment for a patient by completing a MOLST form. Once completed and signed in accordance with sections 2133.34 and 2133.35 of the Revised Code, the MOLST form is valid and, except as provided in division (B) of this section, the instructions in it become operative and govern how the patient who is the subject of the form is to be treated with respect to hospitalization, administration or withdrawal of life-sustaining treatment and comfort care, administration of CPR, and other treatment the director of health has specified in rules adopted under section 2133.31 of the Revised Code.

(B) The instructions in a MOLST form are not operative and do not govern how a patient is to be treated when the form is superseded as described in section 2133.41 of the Revised Code, revoked as described in section 2133.39 of the Revised Code, or when a condition in division (A) or (B) of section 2133.43 of the Revised Code applies.

(C) A physician, physician assistant, or advanced practice nurse shall not have a MOLST form completed for a patient if, subject to division (D) of this section, the patient, or if the patient is incapacitated the individual or class of individuals determined according to the order of priority in division (B) of section 2133.34 of the Revised Code, makes known to the physician, physician assistant, or advanced practice nurse that completion of a MOLST form is not desired.

(D) Any disagreement within a class of individuals as to whether a MOLST form should be completed shall be resolved in accordance with section 2133.36 of the Revised Code.

Sec. 2133.34.  (A) All of the following must participate in the completion of a MOLST form for the form to be valid:

(1) The issuing practitioner, who must sign and date the form in the space designated for the practitioner's signature and who may complete the form or delegate the responsibility of the form's completion to an individual who meets the requirements established in rules adopted under section 2133.31 of the Revised Code;

(2) If the issuing practitioner is not the form preparer, the form preparer, who must sign and date the form in the space designated for the form preparer's signature;

(3) Except as provided in division (B) of this section, the patient, who must sign and date the form in the space designated for the patient's signature.

(B) If the patient is incapacitated, the individual or class of individuals determined in the following descending order of priority and subject to divisions (D) and (E) of this section and section 2133.36 of the Revised Code must sign and date the form in the space designated for such signature or signatures and must indicate the relationship to the patient:

(1) The patient's attorney in fact under the patient's durable power of attorney for health care;

(2) The patient's guardian;

(3) The patient's spouse;

(4) An adult child of the patient or, if there is more than one adult child, all of the patient's adult children;

(5) The patient's parents;

(6) An adult sibling of the patient or, if there is more than one adult sibling, all of the adult's siblings;

(7) The adult not described in divisions (B)(1) to (6) of this section who is most closely related to the patient by blood or adoption;

(8) The individual or class of individuals designated by the director of health in rules adopted under section 2133.31 of the Revised Code.

(C) Division (B)(2) of this section shall not be construed as permitting or requiring the appointment of a guardian for the patient.

(D) If an appropriate individual entitled to participate under division (B) of this section in a MOLST form's completion is not available within a reasonable period of time to participate in the form's completion, is incapacitated, or declines to participate, the next priority individual or class of individuals specified in that division is authorized to participate.

(E) If at least one individual in a class of individuals entitled to participate under division (B) of this section in a MOLST form's completion is incapacitated, is not willing to participate, or is not available within a reasonable period of time, participation shall be limited to the individual or individuals in the class who are not incapacitated and are willing to participate and available within a reasonable period of time.

Sec. 2133.35. (A) When completing a MOLST form, the form preparer shall discuss the instructions in the form with the patient or, if the patient is incapacitated, the appropriate individual or class of individuals determined in accordance with division (B) of section 2133.34 of the Revised Code. The instructions the form preparer lists on the form shall reflect the desires of the patient or, subject to division (C) of this section, the appropriate individual or class of individuals as expressed during the discussion. A declaration or durable power of attorney for health care, or both, if a copy of one or both documents is furnished to the form preparer, may guide the discussion between the form preparer and the patient or appropriate individual or class of individuals.

(B) If a patient participates in the form's completion, the patient may instruct the form preparer to document in the appropriate space on the form that the patient authorizes another individual to do both of the following:

(1) Make all medical decisions on the patient's behalf, including those regarding the administration of CPR and other life-sustaining treatment;

(2) Revoke the form at any time in accordance with the procedure prescribed in rules adopted under section 2133.31 of the Revised Code and complete a new form.

(C) Consistent with division (F) of section 1337.13 of the Revised Code, an attorney in fact under a durable power of attorney for health care or another individual or class of individuals determined in accordance with division (B) of section 2133.34 of the Revised Code does not have the authority to advise that the form preparer make an instruction in a MOLST form inconsistent with an instruction in a declaration or durable power of attorney for health care unless the issuing practitioner and at least one physician who has reviewed the patient's medical record determine that at least one of the following applies:

(1) A change in the physical condition of the patient has significantly decreased the benefit of that instruction to the patient.

(2) The instruction is not, or is no longer, significantly effective in achieving the purpose for which the patient consented to it.

Sec. 2133.36.  (A) Subject to division (B) of this section, if individuals in a class of individuals determined in accordance with division (B) of section 2133.34 of the Revised Code disagree on any decision that must be made with regard to the completion of the form, the opinion of the majority of individuals who are not incapacitated and are available within a reasonable period of time and willing to participate shall prevail.

(B) If a majority of individuals cannot reach a decision under division (A) of this section, a physician who is not the issuing practitioner but who has reviewed the patient's medical record shall make the decision that the physician believes is most consistent with reasonable medical standards.

Sec. 2133.37.  A completed MOLST form shall be placed in a conspicuous location in the paper or electronic medical record of the patient to whom it pertains. Whether maintained as part of a paper or electronic medical record, the form must be readily available and retrievable.

Sec. 2133.38.  If a patient with a MOLST form is transferred from one health care facility to another, the health care facility initiating the transfer shall communicate the existence of, and send a copy of, the form to the receiving facility prior to the transfer. The copy may be sent via regular mail or by facsimile or other electronic means, but if maintained in paper format, must be placed on the color of paper specified in rules adopted under section 2133.31 of the Revised Code on receipt by the receiving facility. A copy of the form is the same as the original.

Consistent with section 2133.37 of the Revised Code, the copy of the MOLST form shall be placed in a conspicuous location in the patient medical record immediately on receipt by the receiving facility. After admission, the attending physician shall review the MOLST form and discuss with the patient or appropriate individual or class of individuals determined in accordance with division (B) of section 2133.34 of the Revised Code whether the form should be amended or revoked and whether a new form should be issued.

If a decision is made to amend the form, the attending physician shall proceed with the amendment consistent with the amendment procedure prescribed in rules adopted under section 2133.31 of the Revised Code. If a decision is made to revoke the form, whether or not there is an intention to issue a new form, the revocation shall be done in accordance with section 2133.39 of the Revised Code.

Sec. 2133.39.  (A) A patient may revoke a MOLST form at any time in accordance with the procedure specified in rules adopted under section 2133.31 of the Revised Code.

(B) If a patient is incapacitated, the individual or class of individuals determined in accordance with division (B) of section 2133.34 of the Revised Code may revoke a form in accordance with the procedure specified in rules adopted under section 2133.31 of the Revised Code if the attending physician determines that at least one of the following is true:

(1) There has been a change in the physical condition of the patient that significantly decreases the benefit of the instructions in the MOLST form to the patient.

(2) The instructions in the MOLST form are no longer significantly effective in achieving the purposes for which the patient, or individual or class of individuals determined in accordance with division (B) of section 2133.34 of the Revised Code, consented to their use.

Sec. 2133.40.  Unless revoked in accordance with section 2133.39 of the Revised Code, a MOLST form does not expire.

Sec. 2133.41.  (A) An instruction in a MOLST form that is inconsistent with an instruction in a do-not-resuscitate order always supersedes the inconsistent instruction in the do-not-resuscitate order.

(B) An instruction in a MOLST form that is inconsistent with an instruction in a general consent to treatment form signed by or on behalf of the patient, a declaration, a durable power of attorney for health care, or a hospital do-not-resuscitate order supersedes the inconsistent instruction in any of those documents unless both of the following are true:

(1) The document was executed after the MOLST form, as evidenced by the date on the document.

(2) The attending physician is made aware of the document and furnished a copy of it.

Sec. 2133.42.  If a section of a MOLST form has not been completed, the attending physician may proceed with the understanding that full treatment relative to treatment covered by that section of the form is to be considered unless the form indicates that the patient has authorized another individual to make all medical decisions on the patient's behalf as described in division (B) of section 2133.35 of the Revised Code.

Sec. 2133.43.  An attending physician may render treatment or take a course of action that is contrary to, or in conflict with, an instruction in a MOLST form if at least one of the following conditions applies:

(A) The patient communicates to the attending physician that the patient desires to be treated in a manner that is contrary to, or in conflict with, an instruction in a MOLST form.

(B) An individual or class of individuals described in division (B) of section 2133.34 of the Revised Code participated in the completion of the MOLST form on behalf of the patient, and the attending physician and another physician who has reviewed the patient's medical record believe, to a reasonable degree of medical certainty and in accordance with reasonable medical standards, that either of the following is true:

(1) A change in the physical condition of the patient has significantly decreased the benefit of the instruction to the patient.

(2) The instruction is not, or is no longer, significantly effective in achieving the purpose for which the individual or class of individuals consented to its use.

Sec. 2133.44. (A) Subject to division (B) of this section, no health care facility, health care professional, or emergency services worker shall be subject to criminal prosecution, liable in damages in tort or other civil action, or subject to professional disciplinary action for acting in accordance with, or otherwise being in compliance with, a valid MOLST form or sections 2133.31 to 2133.48 of the Revised Code.

(B) Division (A) of this section does not grant an immunity from criminal or civil liability or from professional disciplinary action to health care personnel for actions that are outside their scope of authority.

Sec. 2133.45.  The death of an individual that occurs as a result of actions taken consistent with instructions in a MOLST form does not constitute for any purpose a suicide, aggravated murder, murder, or any other homicide.

Sec. 2133.46.  The issuance of a MOLST form shall not do any of the following:

(A) Affect in any manner the sale, procurement, issuance, or renewal of a policy of life insurance or annuity, notwithstanding any term of a policy or annuity to the contrary;

(B) Modify in any manner or invalidate the terms of a policy of life insurance or annuity that is in effect on the effective date of this section;

(C) Impair or invalidate a policy of life insurance or annuity or any health benefit plan.

Sec. 2133.47.  No physician, health care facility, other health care provider, person authorized to engage in the business of insurance in this state under Title XXXIX of the Revised Code, health insuring corporation, other health care benefit plan, legal entity that is self-insured and provides benefits to its employees or members, governmental entity, or other person shall require that an individual be the subject of a MOLST form, or require an individual to revoke or refrain from being the subject of a MOLST form, as a condition of being insured or of receiving health care benefits or services.

Sec. 2133.48.  In the absence of actual knowledge to the contrary and if acting in good faith, an attending physician, other health care professional, emergency services worker, or health care facility may assume that a MOLST form complies with sections 2133.31 to 2133.47 of the Revised Code and is valid.

Section 2. That existing sections 2133.21, 2133.22, 2133.23, 2133.24, and 2133.26 and section 2133.25 of the Revised Code are hereby repealed.

Section 3. (A) There is hereby created the Medical Orders For Life-Sustaining Treatment Advisory Council. The Council shall consist of the following twenty-nine members:

(1) An employee of the Department of Aging, appointed by the Director of Aging;

(2) An employee of the Department of Mental Health, appointed by the Director of Mental Health;

(3) An employee of the Department of Mental Retardation and Developmental Disabilities, appointed by the Director of Mental Retardation and Developmental Disabilities;

(4) The Executive Director of the Ohio Medical Transportation Board;

(5) The Executive Director of the State Board of Emergency Medical Services;

(6) One representative from each of the following organizations, appointed by the president or chief administrative officer of the organization:

(a) The Ohio Hospital Association;

(b) The Ohio State Medical Association;

(c) The Ohio Chapter of the American College of Emergency Physicians;

(d) The Ohio Hospice and Palliative Care Organization;

(e) The Ohio Health Care Association;

(f) The Ohio Ambulance and Medical Transportation Association;

(g) The Ohio Medical Directors Association;

(h) The Ohio Association of Emergency Medical Services;

(i) The Bioethics Network of Ohio;

(j) The Ohio Nurses Association;

(k) The Ohio Academy of Nursing Homes;

(l) The Ohio Association of Professional Firefighters;

(m) The Ohio Osteopathic Association;

(n) The Association of Ohio Philanthropic Homes, Housing and Services for the Aging;

(o) The Catholic Conference of Ohio;

(p) The Ohio Private Residential Association;

(q) The Northern Ohio Fire Fighters Association;

(r) The Ohio Assisted Living Association;

(s) The Ohio Council for Home Care;

(t) Lifeline of Ohio;

(u) The Ohio State Bar Association;

(v) The Ohio Association of Advanced Practice Nurses;

(w) The Ohio Fire Chiefs Association;

(x) The Ohio State Firefighters Association.

(B) The Council shall meet at the call of the Director of Health. The Department of Health shall provide meeting space, staff services, and technical assistance required by the Council in carrying out its duties.

(C) The Council shall advise the Director of Health regarding the rules the Director must adopt under section 2133.31 of the Revised Code. Each member of the Council has one vote. A majority of the members present at a meeting constitutes a quorum, and the affirmative vote of a majority of the members present is necessary for the Council to make an official recommendation to the Director on a particular rule.

The Director may assign other duties to the Council, as the Director considers appropriate.

(D) Members of the Council shall serve without compensation, but shall be reimbursed for their actual and necessary expenses incurred in attending meetings of the Council or performing assignments for the Council.

(E) The Council shall cease to exist on the Director's adoption of initial rules pursuant to section 2133.31 of the Revised Code.