On March 27, 2019 Governor Noem signed into law Senate bill 118 to establish certain provisions regarding advance care planning and allow the execution of a medical order based on a standardized form which is transportable across all healthcare settings and in all facilities. Medical providers in South Dakota and their patients who have been diagnosed with a terminal illness will be able to translate their treatment goals and preferences into actionable medical orders, known as MOST. The purpose of the MOST order form is to ensure all individuals who are facing a terminal condition have the opportunity to discuss their condition with their medical provider and have the opportunity to express their values and preferences for life-sustaining treatment documented in a medical order. South Dakota MOST does not replace an advance healthcare directive (durable power of attorney for healthcare or living will). Both documents work together in a patient-centered approach to honor the values, wishes and goals of each patient.