Advance care directive form pdf

Advance care directive form pdf

A living will (or instruction directive ) alerts medical professionals and your family to the treatments you want to receive or refuse. When will it be used? Advance Care Directive Form.

Advance care directive form pdf

Part I Agent: I want the following person to make health care decisions for me. Part Sign the form Before this form can be use you must: s sign this form if you are at least years of age s have two witnesses sign the form Sign your name and write the date. Who should witness my advance health care directive? Where to get living will forms?

What is an advance directive? An advance directive can be used to name a health care agent. This is someone you trust to make health care decisions for you. Alaska Legal Services Corporation (ALSC) provides this as a service to you and does not take responsibility for how you fill it out.

Advance care directive form pdf

The law allows you to prepare this form on your own. ADVANCE HEALTH CARE DIRECTIVE FORM. The other sections of this division govern the effect of the form or any other writing used to create an advance health care directive. This form is a legal document that lets you name another individual or individuals as your “agent(s)” to make health- care decisions for you if you become incapable of making your own decisions (Part 1). It also allows you to communicate your wishes ahead of time – –regarding your care near the end of life ( Part 2).

Using this form of advance directive for health care is completely optional. Other forms of advance directives for health care may be used in Georgia. You may revoke this completed form at any time.

This completed form will replace any advance directive for health care , durable power of attorney for health care. This document allows an adult to document their preferences for future medical treatment, should they lose decision-making capacity. It will let your family, friends, and medical providers know how you want to be cared for if you cannot speak for yourself. Please share this form with your family, friends, and medical providers.

A Practical Form for All Adults Introduction This form allows you to express your wishes for future health care and to guide decisions about that care. It does not address financial decisions. Although there is no legal requirement for you to have an advance directive , completing this form may help you to receive the health care you desire.

Advance care directive form pdf

It comes into effect only if you are unable to make your own decisions. Give each of them a copy of this form. You should review this form often. You can cancel or change this form at any time.

My signature on this form revokes any living will or power of attorney form naming a health care agent that I have completed in the past. Date Signature _____ City, County, and State of Residence I have witnessed the signing of this directive , I am years of age or older, and I am not: 1. Give the new form to your medical decision maker and medical providers. Five key forms that can assist you are a Health Care Power of Attorney, a Health Decisions Worksheet, a. They may be oral or written. H) SIGNATURE: By writing this advance directive , I inform those who may become entrusted with my health care of my wishes and intend to ease the burdens of decision making which this responsibility may impose. I understand the purpose and effect of this document and sign it knowingly, voluntarily and after careful deliberation.

In New York State there are three types: Health Care Proxy form , Living Will, and Do Not Resuscitate Order (DNR). CPR or cardiopulmonary resuscitation. Keep them informed about your current wishes. A directive can include the type and extent of your medical care. It can help your family and care team better understand your values.

After the documents are file a Registry Card containing a unique file number and password will be issued to the applicant. The applicant can use the file number and password to access the directive (s) online hours a day, days a week, 3days per year. Review your existing forms.