Advance Health Care Directive
The following form is the advanced health care directive form. It consists of 5 key elements.
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Advance Health Care Directive Form Instructions You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. The Advance Health Care Directive form lets you do one or both of these thin\ gs. It also lets you write down your wishes about donation of organs and the selection of your primary physician. If you use the form, \ you may complete or change any part of it or all of it. You are free to use a different form. INSTRUCTIONS Part 1: Power of Attorney Part 1 lets you: PS-X-MHS-442 (Rev. 3-04) MPS/pmd Part 3: Donation of Organs You can write down your wishes about donating your bodily organs and tissues following your death. Part 4: Primary Physician You can select a physician to have primary or main responsibility for your health care. Part 5: Signature and Witnesses After completing the form, sign and date it in the section provided. The form must be signed by two qualified witnesses (see the statements of the witnesses included in the form) or acknowledged before a notary public. A notary is not required if the form is signed by two witnesses. The wittnesses must sign the form on the same date it is signed by the person making the Advance Directive. See part 6 of the form if you are a patient in a skilled nursing facility. Part 6: Special Witness Requirement A Patient Advocate or Ombudsman must witness the form if you are a patient in a skilled nursing facility (a health care facility that provides skilled nursing care and supportive care to patients). See Part 6 of the form. You have the right to change or revoke your Advance Health Care Directive at any time If you have questions about completing the Advance Directive in the hospital, please ask to speak to a Chaplain or Social Worker. We ask that you complete this form in English so your caregivers can understand your directions. ________________________________________________________________________\ ________ ________________________________________________________________________\ ________ ________________________________________________________________________\ ________ Advance Health Care Directive Name________________________________________ Date _________________________________________ You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. This form also lets you write down your wishes regarding donation of organs and the designation of your primary physici\ an. If you use this form, you may complete or change all or any part of it. You are free to use a different form . You have the right to change or revoke this advance health care directive\ at any time. Part 1 — Power of Attorney for Health Care ________________________________________________________________________\ _________________ ________________________________________________________________________\ _________________ ________________________________________________________________________\ _________________ ________________________________________________________________________\ _________________ PS-X-MHS-842 (Rev. 2-04) Page 2 of 4 MPS/PMD ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ___________________________________ ________________________________________________________________________\ ______ PS-X-MHS-842 (Rev. 2-04) Page 3 of 4 MHS/PMD FIRST WITNESS Print Name: ________________________________________________________________________\ ______ Address: ________________________________________________________________________\ ______ Signature of Witness: ________________________________________ Date: ________________________ SECOND WITNESS Print Name: ________________________________________________________________________\ ______ Address: ________________________________________________________________________\ ______ Signature of Witness: ________________________________________ Date: ________________________ PS-X-MHS-842 (Rev. 2-04) Page 4 of 4 MPS/PMDRelevant article from our knowledge database
You may also use an advance directive to state what sorts of treatments you do or don't want, especially the treatments frequently used in a health emergency or close to the conclusion of somebody's life. You may choose to make more than 1 advance directive. You're able to download a California Advance Directive in English in addition to several different languages. The most essential thing on an advance directive is what you conductn't want your health care provider to conduct otherwise a physician will usually conduct everything in his power he feels is needed. The Advance medical Care Directive is important in the event you are incapacitated because it enables you to appoint a medical care agent who has the authority to earn decisions based on your present wishes.
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In case the individual has not chosen a medical Care Agent, the doctor is still required to stick to the persons wishes, as expressed in the Individual healthcare Instructions. He may specify a shorter time if they choose. He may choose to complete either one or both of these parts. The individual making the Advance Directive should maintain a copy in a secure, but accessible spot. These medications may or may not be the same medications he takes routinely. It's not essential for the man or woman to mention an agent or write Individual Health Care Instructions so as to finish an Advance Directive, but the individual must finish the signature section as a way to earn a valid Advance Directive.
The services offered will be a total estate program, including a living trust. Furthermore, before implementing a medical care choice made for the individual, the doctor must promptly inform the individual about the choice and the identity of the individual making the choice. You may want to speak to your doctor or attorney to be sure you have finished the living will in a manner your wishes will be understood.