2021-031 HS, Michigan Physician Orders for Scope of Treatment  
December 6, 2021  
Regulatory Affairs Officer-Good morning, my name is Mary Brennan, and I am the Regulatory Affairs  
Officer for the Department of Health and Human Services. We are the record for 2021-031 HS, Michigan  
Physician Orders for Scope of Treatment or MI-POST. I would like to introduce our subject matter  
expert for this morning.  
Brad Barron: Good morning, I’m Brad Barron. I am the manager of Policy and Strategic Planning for  
RAO: Thank you, Brad. This public hearing will be recorded for transcript and transparency. If you  
would like to make a comment, please come up, take a seat to my right, introduce yourself. Spell your  
name and the organization, if any, that you are speaking on behalf of. The public comment ends Friday,  
December 10th, and if you forgot something today, you can always send it to the email box at MDHHS-  
Are there any questions before we begin?  
And would anyone like to come forward and make a statement?  
Your name please?  
Rena Ruehle: Rena Ruelhle. That’s R-E-N-A, my last name is R-U-E-H-L-E. I am a registered nurse  
working at Spectrum Health in West Michigan, and I work in, solely, in advanced care planning in our  
RAO: Good, and what is your comment this morning.  
RR: I have a couple of comments. The first comment is around, the rules around, pink card stock. And we  
believe that part of the strength of the MI-POST are the portability of these orders and we share  
information and transfer information digitally as health systems in our care entities.  
And so using pink card stock then as things get sent and resent and passed, it will make it very difficult  
to read. We’ve connected with other states who’ve expressed that same, that have been doing POST  
for many more years than we have, and so we really ask that instead of card stock, if we could use a pink  
border to highlight the MI-POST orders instead of card stock. This would also help with operations as  
we have many care locations that would be serving patients that could do a MI-POST and the complexity  
of operations of ensuring they have a printer that is able to print card stock and also have the pink card  
stock available adds complexity. And we believe our, in our communities, we been using the out-of-  
hospital DNR orders on white paper for many years and our first responders have been successful in  
honoring those orders that are on white paper.  
The second comment is around medical interventions being added to the order form itself for  
transparency, and I know others have expressed that concern as well. Um, when looking at adding those  
order forms, if the medical interventions are added to the order form, wondering then whether the  
education could be a changed just to add a check box on the form that they’ve been provided education  
instead of having a separate sheet that they also have to sign that they have been provided that  
education; to just streamline things and make it more efficient.  
Um, speaking of the education, we would really appreciate if DHSS [sic] would post on their website that  
we would be able to use certified translators to translate that document into other languages because  
we serve many individuals that are not English-speaking and would need permission from the State to  
be able to translate a document that is not owned by us.  
And then my last comment is to just make sure that we don’t have conflicts between the FAQ’s and the  
final rules. Right now, there’s conflicts around the timeframes in which orders have to be reaffirmed as  
the patient changes care locations and so we just want to make sure that we don’t have any conflicts in  
those forms as we go live.  
Those are all of my comments.  
RAO: Very good. Ok, thank you very much. Any further comments? Off the record.