Advance Care Planning
|
|
|
- Gertrude Lee
- 5 years ago
- Views:
Transcription
1 What Does It Mean to Be a Health Care Agent? As a health care agent you play an important role in making the medical decisions your loved one would want. It s important you are able to be an advocate on their behalf to medical staff and communicate with the family. Actions and decisions can include: Talking with the medical team and making treatment choices. Asking for a consultation with a specialist or a second opinion. Consenting to stop medical treatment or care. Releasing medical records. Providing for end-of-life care. My health care agent is: Making Your Wishes Known Decisions about health care are personal. These are your decisions to make and are based on your personal values, beliefs and discussions with your loved ones. Next steps can include scheduling an appointment with an Advance Care Planning Facilitator. We offer assistance with these conversations and in completing an advance directive to share with your health care provider, agent and loved ones. The Advance Care Planning community-wide project is sponsored by UnityPoint Health. Name: Address: City: State: Phone: Signature: Advance Care Planning Copyright 2015 UnityPoint Health. All Rights Reserved. SM trademarks of UnityPoint Health a-1 11/15 CS PLAN IN ADVANCE FOR HEALTH CARE DECISIONS
2 Have You Planned for a Serious Injury or Illness? Advance care planning is not just for the ill or elderly, it s something every adult should consider. At any age, an illness or injury could leave you unable to make your own health care decisions. Planning for the future is an important step toward making sure you receive the medical care you would want, even when others must make decisions for you. Advance care planning helps you reflect on your values and beliefs and have discussions about your future wishes. This brochure contains information and questions for you to think about as you plan for the future, and will assist you with sharing your wishes with others and creating an advance directive, a legal document that states your preferences about medical care. What is Advance Care Planning? Advance care planning involves thinking about and having conversations with your family, health care agent, doctors and others about health care decisions you may need to face in the future. It involves learning and considering the types of decisions that may need to be made and letting others know your wishes. From these conversations your wishes can be documented in an advance directive. Talk About Your Wishes A health care agent is someone you choose to make your medical decisions if, in the future, you are unable to make your own. When you think about whom to ask to be your health care agent, there are important things to consider. Usually it is best to name one person or agent to serve at a time, with at least one alternate, in case the first person is not available when needed. It is important to explain what you are asking of your health care agent and talk about why you picked and selected them. Your health care agent needs to know which medical treatments you would want or not want. Your health care agent should be someone who knows you well. This person should be someone you trust, can make decisions in difficult moments, understands and can follow your wishes. The person you select should also be able to ask questions of medical staff on your behalf and communicate with your family and loved ones. Talking to your agent means discussing values, quality-of-life issues, treatments and medical situations. Because situations could occur that you can t anticipate, your agent may need to base a decision on what he or she knows about your values. These are not simple questions, and your views may change over time. For this reason, talk to your agent often especially as your health status views change. Our Advanced Care Planning Facilitators can assist with this process. Consider these questions to discuss with your health care agent: W hat is important to you to live well? W hen would life no longer be worth living? A re there treatments you particularly want to receive or refuse (i.e. mechanical ventilation, antibiotics, or tube feeding for a time)? W hat are you afraid might happen if you can t make decisions for yourself? D o you have any particular fears or concerns about the medical treatments you might receive? Under what circumstances? Ensuring Your Loved Ones Voice is Heard Plan in Advance for Health Care Decisions INFORMATION CARD FOR HEALTH CARE AGENTS has chosen you as their health care agent and to ensure their health care decisions are carried out in the event of an illness or injury in which they can t make their own. What is a Health Care Agent? A health care agent is a person chosen by a loved one to carry out an advance medical directive, which allows you to make their medical treatment decisions, including endof-life, in the event they become ill or injured and can t make or communicate decisions on their own. I have an Advance Health Care Directive. I have selected as my health care agent to make medical decisions on my behalf should I not be able to. My complete advance directive is filed with the following organization: (name and address) KEEP VISIBLY IN WALLET An advance directive is a legal document that goes into effect only if you are unable to speak for yourself. This could be the result of an illness or severe injury no matter how old you are. It helps others know what type of medical care you would want or not want. It also allows you to express your values and wishes. An advance directive is a living document and can be reviewed and updated as your situation changes. Choose a Health Care Agent
3 Have You Planned for a Serious Injury or Illness? Advance care planning is not just for the ill or elderly, it s something every adult should consider. At any age, an illness or injury could leave you unable to make your own health care decisions. Planning for the future is an important step toward making sure you receive the medical care you would want, even when others must make decisions for you. Advance care planning helps you reflect on your values and beliefs and have discussions about your future wishes. This brochure contains information and questions for you to think about as you plan for the future, and will assist you with sharing your wishes with others and creating an advance directive, a legal document that states your preferences about medical care. What is Advance Care Planning? Advance care planning involves thinking about and having conversations with your family, health care agent, doctors and others about health care decisions you may need to face in the future. It involves learning and considering the types of decisions that may need to be made and letting others know your wishes. From these conversations your wishes can be documented in an advance directive. Talk About Your Wishes A health care agent is someone you choose to make your medical decisions if, in the future, you are unable to make your own. When you think about whom to ask to be your health care agent, there are important things to consider. Usually it is best to name one person or agent to serve at a time, with at least one alternate, in case the first person is not available when needed. It is important to explain what you are asking of your health care agent and talk about why you picked and selected them. Your health care agent needs to know which medical treatments you would want or not want. Your health care agent should be someone who knows you well. This person should be someone you trust, can make decisions in difficult moments, understands and can follow your wishes. The person you select should also be able to ask questions of medical staff on your behalf and communicate with your family and loved ones. Talking to your agent means discussing values, quality-of-life issues, treatments and medical situations. Because situations could occur that you can t anticipate, your agent may need to base a decision on what he or she knows about your values. These are not simple questions, and your views may change over time. For this reason, talk to your agent often especially as your health status views change. Our Advanced Care Planning Facilitators can assist with this process. Consider these questions to discuss with your health care agent: W hat is important to you to live well? W hen would life no longer be worth living? A re there treatments you particularly want to receive or refuse (i.e. mechanical ventilation, antibiotics, or tube feeding for a time)? W hat are you afraid might happen if you can t make decisions for yourself? D o you have any particular fears or concerns about the medical treatments you might receive? Under what circumstances? Ensuring Your Loved Ones Voice is Heard Plan in Advance for Health Care Decisions INFORMATION CARD FOR HEALTH CARE AGENTS has chosen you as their health care agent and to ensure their health care decisions are carried out in the event of an illness or injury in which they can t make their own. What is a Health Care Agent? A health care agent is a person chosen by a loved one to carry out an advance medical directive, which allows you to make their medical treatment decisions, including endof-life, in the event they become ill or injured and can t make or communicate decisions on their own. I have an Advance Health Care Directive. I have selected as my health care agent to make medical decisions on my behalf should I not be able to. My complete advance directive is filed with the following organization: (name and address) KEEP VISIBLY IN WALLET An advance directive is a legal document that goes into effect only if you are unable to speak for yourself. This could be the result of an illness or severe injury no matter how old you are. It helps others know what type of medical care you would want or not want. It also allows you to express your values and wishes. An advance directive is a living document and can be reviewed and updated as your situation changes. Choose a Health Care Agent
4 What Does It Mean to Be a Health Care Agent? As a health care agent you play an important role in making the medical decisions your loved one would want. It s important you are able to be an advocate on their behalf to medical staff and communicate with the family. Actions and decisions can include: Talking with the medical team and making treatment choices. Asking for a consultation with a specialist or a second opinion. Consenting to stop medical treatment or care. Releasing medical records. Providing for end-of-life care. My health care agent is: Making Your Wishes Known Decisions about health care are personal. These are your decisions to make and are based on your personal values, beliefs and discussions with your loved ones. Next steps can include scheduling an appointment with an Advance Care Planning Facilitator. We offer assistance with these conversations and in completing an advance directive to share with your health care provider, agent and loved ones. The Advance Care Planning community-wide project is sponsored by UnityPoint Health. Name: Address: City: State: Phone: Signature: Advance Care Planning Copyright 2015 UnityPoint Health. All Rights Reserved. SM trademarks of UnityPoint Health a-1 11/15 CS PLAN IN ADVANCE FOR HEALTH CARE DECISIONS
5 Advance Care Planning Think About Your Wishes These questions may help you with your advance care plan and provide you, your loved ones and care givers with peace of mind. Think about the following questions to have meaningful conversations about your future health care choices. What gives your life its purpose and meaning? What do you value most about your physical or mental well-being? Who among your family and friends are important in your life? Have you talked about your medical care choices with your loved ones when problems arise or death comes close? How would you describe your spiritual or religious life? Do you have a faith community? Do you have cultural or religious beliefs about medical treatment? Have you talked with your doctor or health provider about your health concerns and medical treatment questions? Under what conditions would you want the goals of medical treatment to change from trying to continue your life to focusing on your comfort at end of life? How does cost influence your decisions about medical care? What will be important to you when you are dying (comfort, no pain, family present, music, prayer, being touched or held, etc.)? b1-1 11/15 CS
Making Your Wishes Known With the Help of the Five Wishes Document
Making Your Wishes Known With the Help of the Five Wishes Document Lora Rhodes, MSW, LSW Oncology Social Worker Department of Medical Oncology LBBC: Annual Conference for Women living with Metastatic Breast
HEALTH CARE DIRECTIVE
1 HEALTH CARE DIRECTIVE I,, understand this document allows me to do ONE OR BOTH of the following: PART I: Name another person (called the health care agent) to make health care decisions for me if I am
CHPCA appreciates and thanks our funding partner GlaxoSmithKline for their unrestricted funding support for Advance Care Planning in Canada.
CHPCA appreciates and thanks our funding partner GlaxoSmithKline for their unrestricted funding support for Advance Care Planning in Canada. For more information about advance care planning, please visit
Health Care Directives
Fact Sheet Health Care Directives What is a Health Care Directive? A Health Care Directive is a document that lets you leave instructions about your health care and name a Health Care Agent. A Health Care
VIRGINIA Advance Directive Planning for Important Health Care Decisions
VIRGINIA Advance Directive Planning for Important Health Care Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CARING CONNECTIONS Caring Connections,
Advance Health Care Directive. LIFE CARE planning. my values, my choices, my care. kp.org/lifecareplan
Advance Health Care Directive LIFE CARE planning my values, my choices, my care kp.org/lifecareplan Name of provider: Introduction This Advance Health Care Directive allows you to share your values, your
Health Care Directive
MINNESOTA PATIENT EDUCATION Health Care Directive Making Your Health Care Choices Known My Health Care Directive My health care directive was created to guide my health care agent and family, friends or
ALLINA HOME & COMMUNITY SERVICES ALLINA HEALTH. Advance Care Planning. Discussion guide. Discussion Guide. Advance care planning
ALLINA HOME & COMMUNITY SERVICES ALLINA HEALTH Advance Care Planning Discussion guide Discussion Guide Advance care planning Advance care planning Any of us could think of a time when we might be too sick
Advance Health Care Planning: Making Your Wishes Known. MC rev0813
Advance Health Care Planning: Making Your Wishes Known MC2107-14rev0813 What s Inside Why Health Care Planning Is Important... 2 What You Can Do... 4 Work through the advance health care planning process...
Thinking Ahead. My Way, My Choice, My Life at the End. Dignity. Choice Peace. Trust. Texas Department of Aging and Disability Services
Thinking Ahead My Way, My Choice, My Life at the End There is life, and there is death. You don't know what's going to happen today or tomorrow so you have to be prepared. Dignity Connie Martinez, 2008
Advance Health Care Directive MARYLAND. LIFE CARE planning my values, my choices, my care. kp.org/lifecareplan
Advance Health Care Directive LIFE CARE planning kp.org/lifecareplan MARYLAND Introduction This advance health care directive lets you share your values, your choices, and your instructions about your
ADVANCE CARE PLANNING GOALS OF CARE CONVERSATIONS MATTER A GUIDE FOR MAKING HEALTHCARE DECISIONS
ADVANCE CARE PLANNING GOALS OF CARE CONVERSATIONS MATTER A GUIDE FOR MAKING HEALTHCARE DECISIONS What is Advance Care Planning? Advance Care Planning is a way to help you think about, talk about and document
YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE
YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE YOUR RIGHT TO DECIDE Communicating Your Health Care Choices In 1990, Congress passed the Patient Self-Determination Introduction Act. It requires
Advance Directives. Advance Care Planning & Required Forms. Person Appointing Patient Advocate: Print name Date of Birth Date signed Phone contact(s)
Person Appointing Patient Advocate: Print name Date of Birth Date signed Phone contact(s) Advance Directives Advance Care Planning & Required Forms Keep this document for your records and make copies for
Advance Directive. including Power of Attorney for Health Care
Advance Directive including Power of Attorney for Health Care Overview This is a legal document, developed to meet the legal requirements for Wisconsin. This document provides a way for a person to create
Advance Medical Directives
Advance Medical Directives What Are Advance Medical Directives? These documents could be a living will or a durable power of attorney for health care (also called a health-care proxy). They allow you to
Advance Directive. What Are Advance Medical Directives? Deciding What You Want. Recording Your Wishes
Advance Directive What Are Advance Medical Directives? These documents could be a living will or a durable power of attorney for healthcare (also called a healthcare proxy). They allow you to give directions
munsonhealthcare.org/acp
Advance Care Planning Workbook Making Your Medical Wishes Known Advance Care Planning Workbook 1 munsonhealthcare.org/acp Making Your Medical Wishes Known At any age, a medical crisis could leave someone
HEALTH CARE DIRECTIVE OF
HEALTH CARE DIRECTIVE OF This Health Care Directive shall revoke any prior document granting a power in conflict with a power granted herein. I,, born on, and currently residing at understand this document
Vermont Advance Directive for Health Care
Vermont Advance Directive for Health Care Prepared by the Vermont Ethics Network Explanation and Instructions You have the right to give instructions about what types of health care you want or do not
LIFE CARE planning. Advance Health Care Directive. my values, my choices, my care OREGON. kp.org/lifecareplan
Advance Health Care Directive OREGON LIFE CARE planning kp.org/lifecareplan 60418810_NW All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite
WEST VIRGINIA Advance Directive Planning for Important Health Care Decisions
WEST VIRGINIA Advance Directive Planning for Important Health Care Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program
Advance Directive: Understanding and honoring my future health care goals
mycare Advance Directive: Understanding and honoring my future health care goals My Care, My Choices You might be healthy now, but what if you became very sick or injured in the future and couldn t speak
Last Name: First Name: Advance Directive including Power of Attorney for Health Care
Patient Medical Record Number: Or Label Advance Directive including Power of Attorney for Health Care Overview This legal document meets the requirements for Wisconsin.* It lets you Name another person
MAKING YOUR WISHES KNOWN: Advance Care Planning Guide
MAKING YOUR WISHES KNOWN: Advance Care Planning Guide ADVANCE CARE PLANNING The process of learning about the type of medical decisions that may need to be made, considering those decisions ahead of time
Advance Directive. A step-by-step guide to help you make shared health care decisions for the future. California edition
Advance Directive A step-by-step guide to help you make shared health care decisions for the future California edition Advance Directive Instructions for Patients TALK TO YOUR LOVED ONES This is important.
ILLINOIS Advance Directive Planning for Important Health Care Decisions
ILLINOIS Advance Directive Planning for Important Health Care Decisions CaringInfo 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CaringInfo, a program of the National Hospice
Planning in Advance for Future Health Care Choices Advance Care Planning Information & Guide
Honoring Choices Virginia Planning in Advance for Future Health Care Choices Advance Care Planning Information & Guide Honoring Choices Virginia Imagine You are in an intensive care unit of a hospital.
Advanced Care Planning Guide
Advanced Care Planning Guide A process to think about, talk about and plan for life-threatening illness or end-of-life care New Hampshire Advance Directives: Durable Power of Attorney for Health Care (DPOAH)
Advance [Health Care] Directive
![Advance [Health Care] Directive](/thumbs/77/75352901.jpg "Advance [Health Care] Directive")
Advance [Health Care] Directive Introduction I have completed this Advance Directive with much thought. This document gives my treatment choices and preferences, and/or appoints a Health Care Agent (also
Advance Directives. Important information on health care decision-making: You Have the Right to Decide
Advance Directives Important information on health care decision-making: You Have the Right to Decide The documents provided in this package are being presented to you in accordance with the Federal Patient
Health Care Proxy Appointing Your Health Care Agent in New York State
Health Care Proxy Appointing Your Health Care Agent in New York State The New York Health Care Proxy Law allows you to appoint someone you trust for example, a family member or close friend to make health
MY VOICE (STANDARD FORM)
MY VOICE (STANDARD FORM) a workbook and personal directive for advance care planning WHAT IS ADVANCE CARE PLANNING? Advance care planning is a process for you to: think about what is important to you when
LIFE CARE planning. Advance Health Care Directive. my values, my choices, my care WASHINGTON. kp.org/lifecareplan
Advance Health Care Directive WASHINGTON LIFE CARE planning kp.org/lifecareplan All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 60418811_NW 500 NE Multnomah St., Suite
Last Name: First Name: Advance Directive. including Power of Attorney for Health Care
Overview Patient Medical Record Number: Or Label Advance Directive including Power of Attorney for Health Care This legal document meets the requirements for Wisconsin.* It lets you Name another person
Advance Care Planning Workbook Ontario Edition
Advance Care Planning Workbook Ontario Edition Speak Up Ontario c/o Hospice Palliative Care Ontario, 2 Carlton Street, Suite 808, Toronto, Ontario M5B 1J3 Who will speak for you? Start the conversation.
MY ADVANCE DIRECTIVE
VERSION 09/28/17 MY ADVANCE DIRECTIVE INTRODUCTION This document expresses my preferences about my medical care if I cannot communicate my wishes or make my own health care decisions. I want my family,
Minnesota Health Care Directive Planning Toolkit
Minnesota Health Care Directive Planning Toolkit This planning toolkit contains information to help you: Plan Ahead Understand Common Terms Know the Facts Complete a Health Care Directive: Step-by-Step
Instruction Sheet for Completing Health Care Power of Attorney/Living Will (Please discard instruction sheet after completion of document)
Instruction Sheet for Completing Health Care Power of Attorney/Living Will (Please discard instruction sheet after completion of document) Overview The attached Power of Attorney for Health Care form is
My Wishes for Future Health Care
My Wishes for Future Health Care Information Package Revised on 26 July 2010 Imagine that, without warning, you have developed a life-threatening illness and are in an intensive care unit of a hospital.
North Dakota: Advance Directive
North Dakota: Advance Directive NOTE: This form is being provided to you as a public service. The attached forms are provided as is and are not the substitute for the advice of an attorney. By providing
What would you like to accomplish in the process of advance care planning and/or in completing a health care directive?
Completing a health care directive is an important step in making sure your loved ones and health care providers understand your values and choices for health care treatment if you are not able to speak
HONORING CHOICES MN AND WI HEALTH CARE DIRECTIVE SOMALI
*1628SO* EMMS Foundation: www.metrodoctors.com 612-362-3704 Revised August 2011 Magac Taariikh 1628 so REV 04/05/12 Advance Directives and Living Will ORIGINAL: Patient PHOTOCOPY: Medical Record Page 1
My Voice - My Choice
My Voice - My Choice My Advance Directive Table of Contents Introduction... 2 Words You Need to Know... 3 Legal Document... 4 Helpful Information about your Advance Directive... 10 What makes your life
VIRGINIA Advance Directive Planning for Important Health Care Decisions
VIRGINIA Advance Directive Planning for Important Health Care Decisions Caring Info 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CARING INFO Caring Info, a program of
Advance Care Planning Information
Advance Care Planning Information Booklet Planning in Advance for Future Healthcare Choices www.yourhealthyourchoice.org Life Choices Imagine You are in an intensive care unit of a hospital. Without warning,
INDIANA Advance Directive Planning for Important Health Care Decisions
INDIANA Advance Directive Planning for Important Health Care Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program of
Building a Person-Centered ADVANCE CARE Planning Program. Barbara J. Smith, LBSW, MS, CHC, NHA Carolyn Stramecki, MHSA, CPHQ
Building a Person-Centered ADVANCE CARE Planning Program Barbara J. Smith, LBSW, MS, CHC, NHA Carolyn Stramecki, MHSA, CPHQ Objectives Describe components of an advance directive document required to meet
MISSOURI Advance Directive Planning for Important Healthcare Decisions
MISSOURI Advance Directive Planning for Important Healthcare Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program of
DOWNLOAD COVERSHEET:
DOWNLOAD COVERSHEET: This is a standard advance directive for your state, made available to you as a courtesy by Lifecare Directives, LLC. You should be aware that extensive research has demonstrated that
Advance Directive for Health Care
Advance Directive for Health Care respecting your right to: Choose Your Healthcare Agent Choose the Authority Given to Your Healthcare Agent Choose Your Preferences Related to Treatment & Care Printed
Final Choices Faithful Care
Final Choices Faithful Care A guide to important medical decisions and how to share them with those involved in your care. Mercy Health System is committed to providing care to our patients through all
Health Care Directive
Health Care Directive Overview Adults with decision-making capacity have the right to make choices about their health care. No treatments may be given to someone who does not want them. The attached Durable
peace of mind. Advance care planning document and instructions are enclosed for:
ACP Honoring Choices Booklet_Self Cover 16 PAGES 2-COLOR 01.12.17.qxd_Layout 1 2017-01-12 11:09 Page 3 I choose peace of mind. Take time to plan ahead now so future health care challenges don t create
INSTRUCTIONS FOR COMPLETING A MINNESOTA HEALTH CARE DIRECTIVE
ESTATE & ELDER LAW SERVICES 1900 Central Ave NE, Suite 106 Minneapolis, MN 55418 612-676-6300 Monica Lewis, Attorney at Law Lori D. Skibbie, Attorney at Law INSTRUCTIONS FOR COMPLETING A MINNESOTA HEALTH
Better Ending. A Guide. for a A SSURE Y OUR F INAL W ISHES. Conversations Before the Crisis
A Guide for a Better Ending A SSURE Y OUR F INAL W ISHES Conversations Before the Crisis Information on Advance Care Planning and Documentation from Better Ending, a Program of the Central Massachusetts
California Advance Health Care Directive
California Advance Health Care Directive This form lets you have a say about how you want to be cared for if you get very sick. This form has 3 parts. It lets you: Part 1: Choose a medical decision maker,
LIVING WILL AND ADVANCE DIRECTIVES. Exercise Your Right: Put Your Healthcare Decisions in Writing.
LIVING WILL AND ADVANCE DIRECTIVES Exercise Your Right: Put Your Healthcare Decisions in Writing. Maryland Advance Directive A Message from the Maryland Attorney General Adults can decide for themselves
PENNSYLVANIA Advance Directive Planning for Important Health Care Decisions
PENNSYLVANIA Advance Directive Planning for Important Health Care Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program
LIVING WILL AND ADVANCE DIRECTIVES. Exercise Your Right: Put Your Healthcare Decisions in Writing
LIVING WILL AND ADVANCE DIRECTIVES Exercise Your Right: Put Your Healthcare Decisions in Writing Maryland Advance Directive A Message from the Maryland Attorney General Adults can decide for themselves
MARYLAND Advance Directive Planning for Important Healthcare Decisions
MARYLAND Advance Directive Planning for Important Healthcare Decisions Caring Connections 1731 King St, Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program of
Your Guide to Advance Directives
Starting Points: Your Guide to Advance Directives Values Statements Healthcare Directives Durable Power of Attorney for Healthcare 1 2 Advances in medicine are helping people to live longer than ever before.
LIFE CARE planning. eadvance Health Care Directive. kp.org/lifecareplan. my values, my choices, my care
eadvance Health Care Directive LIFE CARE planning my values, my choices, my care kp.org/lifecareplan 60262511_14_LifeCarePlanningBookletUPDATE.indd 1 Introduction This Advance Health Care Directive allows
1. Share your own personal story about someone you know, or someone you ve read about.
1 I think one of the most powerful ways to begin talking about Advance Health Care Planning is by sharing stories of those who didn t plan. And I have one story/two stories to share with you: 1. Share
II. How strictly I want my agent to follow my instructions:
MY HEALTH CARE CHOICES (OPTIONAL SUPPLEMENT) 1 of 4 Personal Health Care Instructions Communication Form Name: Kaiser MRN#: I. How much I want to know about my condition: (Please mark statement 1 or 2.)
Chapter 2. Advance Care Planning
Chapter 2 Advance Care Planning Chapter 2: Advance Care Planning Discussing Advance Directives with Your Patients Advance care planning allows patients to indicate how they want to be treated if they
Hospice Care for anyone considering hospice
A decision aid for Care for anyone considering hospice You or a loved one have been diagnosed with a serious illness that might not be curable. Many people find this scary or confusing. Some people feel
California Advance Health Care Directive
California Advance Health Care Directive This form lets you have a say about how you want to be treated if you get very sick. This form has 3 parts. It lets you: Part 1: Choose a health care agent. A health
YOUR RIGHT TO MAKE YOUR OWN HEALTH CARE DECISIONS
Upon admission to Western Connecticut Health Network, you will be asked if you have any form of an Advance Directive such as a Living Will or a Health Care Representative. If you have such a document,
MARYLAND ADVANCE DIRECTIVE PLANNING FOR FUTURE HEALTH CARE DECISIONS
MARYLAND ADVANCE DIRECTIVE PLANNING FOR FUTURE HEALTH CARE DECISIONS A guide to Maryland Law on Health Care Decisions (Forms Included) State of Maryland Office of the Attorney General Dear Fellow Marylander:
MARYLAND Advance Directive Planning for Important Healthcare Decisions
MARYLAND Advance Directive Planning for Important Healthcare Decisions Caring Info 1731 King St, Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Info, a program of the National Organization
NEW HAMPSHIRE Advance Directive Planning for Important Health Care Decisions
NEW HAMPSHIRE Advance Directive Planning for Important Health Care Decisions CaringInfo 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 CaringInfo, a program of the National
Cynthia Ann LaSala, MS, RN Nursing Practice Specialist Phillips 20 Medicine Advisor, Patient Care Services Ethics in Clinical Practice Committee
Cynthia Ann LaSala, MS, RN Nursing Practice Specialist Phillips 20 Medicine Advisor, Patient Care Services Ethics in Clinical Practice Committee What is Advance Care Planning (ACP)? Understanding/clarifying
Advance Care Planning and Goals of Care
Advance Care Planning and Goals of Care A Guide For Patients with A Serious Illness and Their Families Nova Scotia Edition www.nshpca.ca Receiving a diagnosis of a serious illness can be life altering.
Health Care Directive
Health Care Directive Overview Adults with decision-making capacity have the right to make choices about their health care. No treatments may be given to someone who does not want them. The attached Durable
MY ADVANCE CARE PLANNING GUIDE
MY DVNCE CRE PLNNING GUIDE Let s TLK! Tell us your values and beliefs about your healthcare. Take time to have the conversation with your physician and your family. lways be open and honest. Leave no doubt
Your Health Care Proxy
Your Health Care Proxy Congratulations on taking a step towards completing your Massachusetts Health Care Proxy form! What is a Health Care Proxy? A health care proxy (or health care agent ) is someone
MARYLAND ADVANCE DIRECTIVE: PLANNING FOR FUTURE HEALTH CARE DECISIONS
MARYLAND ADVANCE DIRECTIVE: PLANNING FOR FUTURE HEALTH CARE DECISIONS A Guide to Maryland Law on Health Care Decisions (Forms Included) STATE OF MARYLAND OFFICE OF THE ATTORNEY GENERAL Douglas F. Gansler
What Are Advance Medical Directives?
What Are Advance Medical Directives? UAMS would like you to know there are ways to let others know what decisions you would want to make about your medical treatments, even when you are unable to speak
MY ADVANCE CARE PLANNING GUIDE
MY DVNCE CRE PLNNING GUIDE Let s TLK! Tell us your values and beliefs about your healthcare. Take time to have the conversation with your physician and your family. lways be open and honest. Leave no doubt
Health Care Directive. Choose whether you want life-sustaining treatments in certain situations.
Durable Power of Attorney (DPOA) for Health Care Health Care Directive Documents are legally valid in Washington What is advance care planning? Advance care planning is for all adults 18 and older. It
Health Care Directive. Choose whether you want life-sustaining treatments in certain situations.
Durable Power of Attorney (DPOA) for Health Care Health Care Directive Documents are legally valid in Washington What is advance care planning? Advance care planning is for all adults 18 and older. It
WISCONSIN Advance Directive Planning for Important Health Care Decisions
WISCONSIN Advance Directive Planning for Important Health Care Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program
Planning in Advance for Your Health Care
Planning in Advance for Your Health Care This booklet will help you to plan ahead. If you have any questions please call for assistance: NWH Patient Relations Representative 617-243-5052 NWH Pastoral Care:
TO HELP EASE DECISION MAKING IN THE FUTURE ADVANCE CARE PLANNING TOOLKIT
TO HELP EASE DECISION MAKING IN THE FUTURE ADVANCE CARE PLANNING TOOLKIT Advance Care Planning Toolkit Your health care decisions are important. Providing Patient Centered Care is the guiding principle
ABOUT ADVANCE DIRECTIVES
ABOUT ADVANCE DIRECTIVES You have a right to decide what treatments you want or don t want, and who makes these decisions should you be unable to make them for yourself. This booklet will tell you how.
Planning Today for Tomorrow s Healthcare: A Guide for People with Chronic KIDNEY DISEASE
Planning Today for Tomorrow s Healthcare: A Guide for People with Chronic KIDNEY DISEASE 1 Hi, I am Irene Smith, a 65-yearold CKD patient. I have a plan. Let me tell you my story. OVERVIEW When I was
New Jersey Appointment of a Health Care Representative
Instructions Print your name Print the name, address and home and work telephone numbers of your health care rep. New Jersey Appointment of a Health Care Representative I,, (name) hereby appoint: (name
Planning Ahead: How to Make Future Health Care Decisions NOW. Washington
Washington Planning Ahead: How to Make Future Health Care Decisions NOW Your Questions Answered About Washington Living Wills and Powers of Attorney for Health Care Table of Contents P 1 What You Need
Printed from the Texas Medical Association Web site.
Printed from the Texas Medical Association Web site. Medical Power of Attorney Patient and Health Care Provider Information September 1999 General Information To be read by the Patient and Health Care
MEDICAL POWER OF ATTORNEY DESIGNATION OF HEALTH CARE AGENT.
MEDICAL POWER OF ATTORNEY DESIGNATION OF HEALTH CARE AGENT. I, (insert your name) appoint: Name Address Phone as my agent to make any and all health care decisions for me, except to the extent I state
COMMUNICATE YOUR HEALTH CARE WISHES. California Advance Health Care Directive Kit
COMMUNICATE YOUR HEALTH CARE WISHES. California Advance Health Care Directive Kit CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE Give your loved ones peace of mind; make your wishes known now. This form lets
POWER OF ATTORNEY FOR HEALTH CARE
POWER OF ATTORNEY FOR HEALTH CARE Name: Date of Birth: Address: Telephone: I intend by this document to create a Power of Attorney for Health Care. My executing this power of attorney is voluntary. I expect
I,,, Social Security number
Durable power of attorney for health care choices & health care choices DIRECTIVE 6- FORM Part I. Durable power of attorney for health care choices I,,, Name Social Security number appoint,, Name Phone
ADVANCE DIRECTIVES. A Guide for Patients and Their Families.
ADVANCE DIRECTIVES A Guide for Patients and Their Families www.kidney.org Thinking about things like sickness and death is not easy for anyone. Yet, each of us may be faced with choices concerning life
Statement of Choices ADVANCE CARE PLANNING.
Statement of Choices ADVANCE CARE PLANNING This Statement of Choices will help you record your wishes, values and beliefs to guide those close to you to make health care decisions on your behalf if you
ADVANCE DIRECTIVE. 289 LaClair St, Coos Bay, OR Voice: Fax: TTY:
ADVANCE DIRECTIVE What do I need to know? If you are an adult, you have the right to know about any medical treatment your doctor recommends for you and to refuse it if you choose. However, a serious illness
TENNESSEE Advance Directive Planning for Important Healthcare Decisions
TENNESSEE Advance Directive Planning for Important Healthcare Decisions Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 Caring Connections, a program of
Advance Medical Directives
Caring for the Paperwork Advance Medical Directives When your terminally ill loved one is too sick or mentally unable to express their wishes concerning health care, legal documentation known as advance
LOUISIANA ADVANCE DIRECTIVES
LOUISIANA ADVANCE DIRECTIVES Legal Documents that Ensure that Your Choices for Future Medical Care or the Refusal of Same are Honored and Implemented by Your Health Care Providers Peoples Health is a Medicare