(1) A physician order for sustaining treatment (POST) directing health care in the standardized form provided by this section may be executed by the primary physician of an individual and:

(a) The individual, if an adult or emancipated minor with capacity; or

(b) The agent, guardian, or surrogate having authority to make health care decisions on behalf of the individual if the individual is:

(i) An unemancipated minor; or

(ii) An adult or emancipated minor who lacks capacity.

(2) The physician order for sustaining treatment shall be executed, implemented, reviewed, and revoked in accordance with the instructions on the form.

(3) The State Board of Medical Licensure shall promulgate a standardized physician order for sustaining treatment form in accordance with the provisions in this section, adhering to the sequence in those provisions and using checkboxes to indicate the various alternatives. The board shall consult with appropriate professional and advocacy organizations in developing the physician order for sustaining treatment form, including the Mississippi Hospital Association, the Mississippi State Medical Association, Mississippians for Emergency Medical Services, the Mississippi Health Care Association, the Mississippi Independent Nursing Home Association, the Louisiana-Mississippi Hospice and Palliative Care Organization, Disability Rights Mississippi, Mississippi Right to Life, the Mississippi Bar Association and the Mississippi Section of American Congress of Obstetricians and Gynecologists.

The physician order for sustaining treatment form shall begin with an introductory section containing the name “POST, Physician Orders for Sustaining Treatment,” the patient’s name, patient’s date of birth, the effective date of the form followed by the statement “Form must be reviewed at least annually.”, and containing the statements “HIPAA permits disclosure of POST to other health care professionals as necessary” and “This document is based on this person’s current medical condition and wishes and is to be reviewed for potential replacement in the case of a substantial change in either. Any section not completed indicates preference for full treatment for that section.”

(a) Section A of the form shall direct provision or withholding of cardiopulmonary resuscitation to the patient when he or she has no pulse and is not breathing by selecting one (1) of the following:

(i) Attempt Resuscitation (CPR); or

(ii) Do Not Attempt Resuscitation (DNR); and include the statement “When not in cardiopulmonary arrest, follow orders in B, C, and D.”

(b) Section B of the form shall direct the sustaining treatment when the patient has a pulse or is breathing by selecting one (1) of the following:

(i) Full Sustaining Treatment, including the use of intubation, advanced airway interventions, mechanical ventilation, defibrillation or cardio version as indicated, medical treatment, intravenous fluids, and comfort measures. This option shall include the statement “Transfer to a hospital if indicated. Includes intensive care. Treatment Plan: Full treatment including life support measures”;

(ii) Limited Interventions, including the use of medical treatment, oral and intravenous medications, intravenous fluids, cardiac monitoring as indicated, noninvasive bi-level positive airway pressure, a bag valve mask, and comfort measures. This option excludes the use of intubation or mechanical ventilation. This option shall include the statement “Transfer to a hospital if indicated. Avoid intensive care. Treatment Plan: Provide basic medical treatments”; or

(iii) Comfort Measures, including keeping the patient clean, warm, and dry; use of medication by any route; positioning, wound care, and other measures to relieve pain and suffering; and the use of oxygen, suction, and manual treatment of airway obstruction as needed for comfort. This option shall include the statement “Do not transfer to a hospital unless comfort needs cannot be met in the patient’s current location (e.g., hip fracture),” and include a space for other instructions.

(c) Section C of the form shall direct the use of oral and intravenous antibiotics by selecting one (1) of the following:

(i) Antibiotics if life can be sustained;

(ii) Determine use or limitation of antibiotics when infection occurs;

(iii) Use antibiotics only to relieve pain and discomfort; and include a space for other instructions.

(d) Section D of the form, which shall have the heading “Medically Administered Fluids and Nutrition: Administer oral fluids and nutrition if physically possible,” shall include the following options:

(i) Directing the administration of nutrition into blood vessels if physically feasible as determined in accordance with reasonable medical judgment by selecting one (1) of the following:

1. Total parenteral nutrition long-term if indicated;

2. Total parenteral nutrition for a defined trial period, which option shall be followed by “Goal:” and a blank line; or

3. No parenteral nutrition;

(ii) Directing the administration of nutrition by tube if physically feasible as determined in accordance with reasonable medical judgment by selecting one (1) of the following:

1. Long-term feeding tube if indicated;

2. Feeding tube for a defined trial period, which option shall be followed by “Goal:” and a blank line; or

3. No feeding tube;

(iii) Directing the administration of hydration, if physically feasible as determined in accordance with reasonable medical judgment, by selecting one (1) of the following:

1. Long-term intravenous fluids if indicated;

2. Intravenous fluids for a defined trial period, which option shall be followed by “Goal:” and a blank line; or

3. Intravenous fluids only to relieve pain and discomfort.

(e) Section E of the form, which shall have the heading “Patient Preferences as a Basis for this POST Form,” shall include the following:

(i) A direction to indicate whether or not the patient has an advance health-care directive as defined in Section 41-41-203 and if so, the date of the advance directive’s execution, and, a certification that the physician order for sustaining treatment is in accordance with the advance directive, followed by the printed name, position, and signature of an individual so certifying;

(ii) If the patient is an unemancipated minor, an indication of by which one or more of the following directions were given in accordance with Section 41-41-3:

1. Minor’s guardian or custodian;

2. Minor’s parent;

3. Adult brother or sister of the minor;

4. Minor’s grandparent; or

5. Adult who has exhibited special care and concern for minor; and

(iii) If the patient is an adult or an emancipated minor, by which one or more of the following directions were given in accordance with Section 41-41-205, 41-41-211 or 41-41-213:

1. Patient;

2. Agent authorized by patient’s power of attorney for health care;

3. Guardian of the patient;

4. Surrogate designated by patient;

5. Spouse of patient (if not legally separated);

6. Adult child of the patient;

7. Parent of the patient;

8. Adult brother or sister of the patient; or

9. Adult who has exhibited special care and concern for the patient and is familiar with the patient’s values.

(f) A signature portion of the form, which shall include lines for the printed name, signature, and date of signing for:

(i) The patient’s primary physician;

(ii) The individual or individuals described in paragraph (e)(ii) or (iii) of this subsection; and

(iii) The health care professional preparing the form, if other than the patient’s primary physician, with contact information.

(g) A section entitled “Information for patient or representative of patient named on this form,” which shall include the following language:

(h) A section entitled “Directions for Completing and Implementing Form,” which shall include the following four (4) subdivisions:

(i) The first subdivision, entitled “Completing POST,” shall have the following language:

(ii) The second subdivision, entitled “Implementing POST,” shall have the following language:

(iii) The third subdivision, entitled “Reviewing POST,” shall have the following language:

(iv) The fourth subdivision, entitled “Revocation of POST,” shall have the following language:

(i) A section entitled “Review of POST,” which shall include the following columns and a number of rows determined by the State Board of Medical Licensure:

(i) Review Date;

(ii) Reviewer and Location of Review;

(iii) MD/DO Signature (Required); and

(iv) Signature of Patient or Representative (Required).

(j) A section entitled “Outcome of Review,” which shall include descriptions of the outcome in each row by selecting one (1) of the following:

(i) No Change;

(ii) FORM VOIDED, new form completed; or

(iii) FORM VOIDED, no new form.