Home Health Orientation Manual FEDERAL Edition
|
|
- Leslie Sanders
- 6 years ago
- Views:
Transcription
1 Home Health Orientation Manual FEDERAL Edition Foundation Management Services, Inc. 3Q/2010. (FEDERAL)
2 Home Health Orientation Manual FEDERAL Edition Table of Contents Orientation Checklist CHAPTER 9 CHAPTER 1 Performance Improvement Advance Directives CHAPTER 10 CHAPTER 2 Safety Compliance CHAPTER 11 CHAPTER 3 Patient Rights / Cultural Diversity Documentation CHAPTER 12 CHAPTER 4 OASIS Start of Care Admission Employee Health/Infection Control C H A P T E R 1 3 CHAPTER 5 Public Reporting HIPAA & Red Flag Rule C H A P T E R 1 4 CHAPTER 6 Ethics and Conflict of Interest Home Care 101 CHAPTER 7 Introduction to OASIS and PPS CHAPTER 8 OASIS Assessment, Documentation and Audit Foundation Management Services, Inc. 3Q/2010. (FEDERAL)
3 Chapter 1 Advance Directives PURPOSE: To educate the new home health employee in the patient s right to make Advance Directives. O bjectives: The employee will have express knowledge of Advance Directives, understand how to honor a patients Advance Directive and be able to recognize an Out of Hospital Do Not Resuscitate Order, if allowed by the state. Upon admission to home health care, each individual is provided with written information regarding his/her right to make decisions about medical care, and to accept or refuse medical or surgical treatment. This may include verification of decisions made in a Living Will or Directive to Physician or in a Medical Power of Attorney. It may also include determinations needed to implement specified treatment when terminal illness or patient incompetence is a factor. Patients and families are encouraged to discuss the issue with their physician and/or attorney. Any interaction and coordination of services is to be documented in the clinical record. All patients will be treated with acceptable professional standards of care without discrimination, and the presence or absence of an Advance Directive will not affect the quality of care provided by the Agency.
4 DIRECTIVE TO PHYSICIAN Sets out the desires of a person ahead of time Directs the physician to withhold or withdraw life-sustaining procedures when the patient becomes qualified Qualified patient means a patient with a terminal condition that has been diagnosed and certified in writing by the attending physician and one other physician who has examined the patient Terminal condition means an incurable or irreversible condition, which would produce death without the application of life-sustaining procedures, or only postpone the moment of death with the application of life-sustaining procedures MEDICAL POWER OF ATTORNEY (MPOA) Allows the person to appoint someone to make health care decisions for him if he is no longer able to make decisions for himself Does not include the requirement that the patient be terminally ill The MPOA becomes effective only when the patient is incapacitated The patient should pick a strong patient advocate who will not be intimidated by physicians or other family members In the absence of MPOA, the law turns decision making authority over to the relatives in the following order of priority (a court appointed legal guardian may take the place of a relative), but a court may decide that the decision maker is not acting in the patient s best interest 1) Spouse of patient 2) Adult child of the patient who has the consent of the other adult children to act as the decision maker 3) A majority of the patient s available adult children 4) The patient s parents 5) The person clearly identified to act for the patient by the patient before the patient became incapacitated
5 OUT OF HOSPITAL DO NOT RESUSCITATE (OOHDNR) Allows the patient to refuse life-sustaining treatments in any setting outside of a hospital Protects EMS personnel from liability Must use the State approved form Does not require a terminal condition, except for minors Requires the signature of the patient or proper person acting on behalf of the patient, two witnesses and one physician Patients who want a DNR are not required to use the state form, however EMS personnel may not honor any form but the state form If the patient was a DNR in the hospital, you can use that order in home care DEATH AND DYING/DETERMINATION & PRONOUNCEMENT OF DEATH All clinical personnel should receive information regarding death and dying to optimize patient dignity and comfort, and facilitate coping mechanisms demonstrated by patient and family. A RN may pronounce a patient dead and complete the Determination and Pronouncement of Death by a Registered Nurse form according to State law and agency policy. There also must be in place an appropriate DNR order. This includes the Physician s Agreement for Pronouncement of Death by a Registered Nurse. All patient care team members must be informed of each patient s choice regarding Advance Directives. POINTS TO REMEMBER ABOUT ADVANCE DIRECTIVES The patient is legally entitled to make informed decisions about accepting or refusing medical care. Health care providers are required to educate patients and the public about Advance Directives. The making of an Advance Directives is not a requirement for the admission to health care services. The contents of an Advance Directive should be communicated to all health care providers. Advance Directives can be revoked or changed at any time.
6 Attorneys are not required to prepare a directive, but each directive must be legally executed. Directives must be executed by competent adults. Directives can be written and oral. Directives must be witnessed by two witnesses who affirm that the patient states in their presence that the patient was aware of the nature of the directive and that the patient signed it voluntarily and free from duress, and at least one of the witnesses must meet the following requirements: 1) Cannot be the person designated as agent 2) Cannot be a health or residential care provider or an employee of the patient s health or residential care provider 3) Cannot be related to the patient by blood or marriage 4) Cannot be lawful heirs or beneficiaries named in the patient s will or a deed 5) Cannot be a creditor or persons who have a claim against the patient s estate 6) Cannot be a patient in the health care facility in which the declarant is a patient.
7 ADVANCE DIRECTIVES TEST T F 1. It is a patient s right to receive information regarding advance directives. T F 2. A living will is the same as a Do Not Resuscitate order. T F 3. Patients should be instructed to have copies of all advance directives available to all health care workers. T F 4. Only a physician can pronounce death in the home care setting. T F 5. A patient must contact an attorney to complete any advance directive. T F 6. A Medical Power of Attorney is the same thing as a Durable Power of Attorney. T F 7. If the patient was a DNR in the hospital, you can use that order in home care. T F 8. There are three types of advance directives and a patient might have all three. T F 9. All clinical staff must be made aware of the patient s advance directives. T F 10. A patient must have some sort of advance directive before being admitted to home care. Employee Name Printed name Date Score Supervisor
8 ADVANCE DIRECTIVES ANSWER KEY T 1. It is a patient s right to receive information regarding advance directives. F 2. A living will is the same as a Do Not Resuscitate order. T 3. Patients should be instructed to have copies of all advance directives available to all health care workers. F 4. Only a physician can pronounce death in the home care setting. F 5. A patient must contact an attorney to complete any advance directive. F 6. A Medical Power of Attorney is the same thing as a Durable Power of Attorney. T 7. If the patient was a DNR in the hospital, you can use that order in home care. T 8. There are three types of advance directives and a patient might have all three. T 9. All clinical staff must be made aware of the patient s advance directives. F 10. A patient must have some sort of advance directive before being admitted to home care.
SOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY
SOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY INFORMATION ABOUT THIS DOCUMENT THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS: 1. THIS DOCUMENT GIVES
More informationRHODE ISLAND DECLARATION
RHODE ISLAND DECLARATION I,, being of sound mind willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below, do hereby declare:
More informationYour Right to Make Health Care Decisions in Colorado
Your Right to Make Health Care Decisions in Colorado This e-book informs you about your right to make health care decisions, including the right to accept or refuse medical treatment. It explains the following
More informationMaking Decisions About Your Health Care. (Information about Durable Power of Attorney for Health Care and Living Wills)
Making Decisions About Your Health Care (Information about Durable Power of Attorney for Health Care and Living Wills) Following guidelines set by federal regulations, we would like to inform you of your
More informationLOUISIANA ADVANCE DIRECTIVES
LOUISIANA ADVANCE DIRECTIVES Legal Documents To Make Sure Your Choices for Future Medical Care or the Refusal of Same are Honored and Implemented by Your Health Care Providers ADVANCE DIRECTIVES INTRODUCTION
More informationPlanning 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
More informationTitle: ADVANCE DIRECTIVES: LIVING WILL AND MENTAL HEALTH
Title: ADVANCE DIRECTIVES: LIVING WILL AND MENTAL HEALTH Scope: The provisions in this policy relating to Mental Health Advance Directives (MHAD) apply to health care providers in both inpatient and outpatient
More informationDURABLE POWER OF ATTORNEY FOR HEALTH CARE (Missouri Revised Statutes to )
DURABLE POWER OF ATTORNEY FOR HEALTH CARE (Missouri Revised Statutes 404.800 to 404.865) THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT YOU SHOULD KNOW THESE IMPORTANT FACTS: Except
More informationPrinted 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
More informationBasic Guidelines for Using the Advance Health Care Directive Form
Basic Guidelines for Using the Advance Health Care Directive Form Is this AHCD different from a durable power of attorney for health care or declaration to physician? Yes and no. The other two forms are
More informationSAMPLE FLORIDA HEALTH CARE DIRECTIVE (LIVING WILL / DESIGNATION OF HEALTH CARE SURROGATE) Jane Doe
FLORIDA HEALTH CARE DIRECTIVE (LIVING WILL / DESIGNATION OF HEALTH CARE SURROGATE) OF Jane Doe [This section will appear if you select living will and will vary depending on your choices in regards to
More informationMISSOURI HEALTH CARE DIRECTIVE AND DURABLE POWER OF ATTORNEY FOR HEALTH CARE SAMPLE. Jane Doe
MISSOURI HEALTH CARE DIRECTIVE AND DURABLE POWER OF ATTORNEY FOR HEALTH CARE I. HEALTH CARE DIRECTIVE OF Jane Doe 1. I, Jane Doe, make this HEALTH CARE DIRECTIVE ( Directive ) to exercise my right to determine
More informationYour Right to Make Health Care Decisions
42 P O Box 10600 Grand Junction, CO 81502-5600 Your Right to Make Health Care Decisions Advance Directives What is an Advance Directive? It is a type of written instruction about your health care to be
More informationYOUR 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
More informationPresident & CEO ADVANCE DIRECTIVES POLICY:
Page 1 of 4 REVIEWED DATES REVISED DATES APPROVED BY: 11/1991 11/1991 Patient Safety, Quality Management & Regulatory Affairs 04/2008 04/2008 APPROVED BY: 02/2011 02/2011 President & CEO Administrative
More informationAdvance Health Care Directive Form Instructions
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
More information(4) "Health care power of attorney" means a durable power of attorney executed in accordance with this section.
SOUTH CAROLINA STATUTES SECTION 62-5-504. Definitions. (A) As used in this section: (1) "Agent" or "health care agent" means an individual designated in a health care power of attorney to make health care
More informationMEDICAL POWER OF ATTORNEY
MEDICAL POWER OF ATTORNEY DESIGNATION OF HEALTH CARE AGENT. I, (insert your name) appoint: Phone: as my agent to make any and all health care decisions for me, except to the extent I state otherwise in
More informationCALIFORNIA ADVANCE HEALTH CARE DIRECTIVE
CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE Explanation 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.
More informationMEDICAL 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
More informationPart One: Durable Power of Attorney for Health Care Decisions GRANT OF AUTHORITY TO AGENT. I,, (name) designate and appoint: (name of agent) (address)
INSTRUCTIONS KANSAS ADVANCE DIRECTIVE PAGE 1 OF 5 Part One: Durable Power of Attorney for Health Care Decisions GRANT OF AUTHORITY TO AGENT PRINT YOUR NAME PRINT THE NAME, ADDRESS, AND TELEPHONE NUMBERS
More informationSOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY
SOUTH CAROLINA HEALTH CARE POWER OF ATTNEY INFMATION ABOUT THIS DOCUMENT THIS IS AN IMPTANT LEGAL DOCUMENT. BEFE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPTANT FACTS: 1. THIS DOCUMENT GIVES THE PERSON
More informationPURPOSE: POLICY: not
PAGE: 1 EFFECTIVE: 3/2007 7/2013 / 04/10/2015 PURPOSE: The purpose of this policy is to provide an atmosphere of respect and caring and to ensure that each patient's ability and right to participate in
More informationObjectives. 1. Understand the different Advance Directives options available in WI. 2. Understand the benefits of completing an Advance Directive
Advance Directives Objectives 1. Understand the different Advance Directives options available in WI 2. Understand the benefits of completing an Advance Directive 3. Define the role that IDT staff in educating
More informationMedical Power of Attorney Designation of Health Care Agent 2 Witnesses. I, (insert your name) appoint: Name: Address:
Medical Power of Attorney Designation of Health Care Agent 2 Witnesses I, (insert your name) appoint: Phone: as my agent to make any and all health care decisions for me, except to the extent I state otherwise
More informationAdvance Directives. Making your health care choices known if you can't speak for yourself.
Advance Directives Making your health care choices known if you can't speak for yourself. ADVANCE DIRECTIVES Making your health care choices known if you can t speak for yourself This booklet contains
More informationADVANCE HEALTH CARE DIRECTIVE Including Power of Attorney for Health Care (California Probate Code Sections effective JULY 1, 2000)
ADVANCE HEALTH CARE DIRECTIVE Including Power of Attorney for Health Care (California Probate Code Sections 4600-4805 effective JULY 1, 2000) Introduction. This form lets you exercise your right to give
More information~ Massachusetts ~ Health Care Proxy Christian Version
~ Massachusetts ~ Health Care Proxy Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT You have the right to make decisions about your health care. No health care may be given to you over your objection,
More informationSTATUTORY FORM ADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701)
STATUTORY FORM ADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701) EXPLANATION You have the right to give instructions about your own health care. You also have the right to name someone
More informationAdvance [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
More informationADVANCE MEDICAL DIRECTIVES
Advance Directives ADVANCE MEDICAL DIRECTIVES The "Montana Rights of the Terminally Ill Act" (also known as the Montana Living Will Act") allows individuals the maximum possible control over their own
More informationSutton Place Behavioral Health, Inc. POLICY NO. CLM-19 EFFECTIVE DATE:
Sutton Place Behavioral Health, Inc. POLICY NO. CLM-19 EFFECTIVE DATE: 03-17-04 HEALTH CARE ADVANCE DIRECTIVES ATTACHMENTS: Living Will Designation of Health Care Surrogate Wallet card Advance Directives
More informationADVANCE HEALTH CARE DIRECTIVE. (California Probate Code Section 4701) Explanation
ADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701) Explanation You have the right to give instructions about your own health care. You also have the right to name someone else to make
More informationNorth 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
More information~ Colorado. Medical Durable Power of Attorney for Healthcare Decisions Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT
~ Colorado ~ Medical Durable Power of Attorney for Healthcare Decisions Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT You have the right to make decisions about your health care. No health care
More informationAdvance Health Care Directives. Form Instructions
Advance Health Care Directives 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.
More informationABOUT 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.
More informationINFORMATION CONCERNING THE MEDICAL POWER OF ATTORNEY
INFORMATION CONCERNING THE MEDICAL POWER OF ATTORNEY THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS: Except to the extent you state otherwise,
More informationAdvance Directive Form
Advance Directive Form 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 these forms
More informationDURABLE POWER OF ATTORNEY
Page1 DURABLE POWER OF ATTORNEY FOR HEALTH CARE I,, am of sound mind and I (Print or type your full name) voluntarily make this designation. APPOINTMENT OF PATIENT ADVOCATE I designate, my (Insert name
More informationSaint Agnes Medical Center. Guidelines for Signers
597 Saint Agnes Medical Center Page 1 Guidelines for Signers What is an Advance Health Care Directive? An "Advance Health Care Directive" is a document you can use to appoint another person, such as a
More information~ Minnesota. Durable Power of Attorney for Health Care Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT
~ Minnesota ~ Durable Power of Attorney for Health Care Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT YOU HAVE THE RIGHT TO MAKE DECISIONS ABOUT YOUR HEALTH CARE. NO HEALTH CARE MAY BE GIVEN
More informationADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701)
ADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701) For: EXPLANATION You have the right to give instructions about your own health care. You also have the right to name someone else to
More informationARIZONA HEALTH CARE DIRECTIVE SAMPLE (LIVING WILL / HEALTH CARE POWER OF ATTORNEY) John Doe
ARIZONA HEALTH CARE DIRECTIVE (LIVING WILL / HEALTH CARE POWER OF ATTORNEY) OF John Doe I, John Doe, being of sound mind and disposing mind and memory, do hereby make and declare this to be my health care
More informationCALIFORNIA ADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701)
CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701) You have the right to give instructions about your own health care. You also have the right to name someone else to make
More informationCalifornia Code of Regulations, Title 22, Section 73524; Department of Mental Health, Special Order
Coalinga State Hospital OPERATING MANUAL SECTION - MEDICAUNURSING SERVICES ADMINISTRATIVE DIRECTIVE NO. 564 (Replaces A.D. No. 564 dated 4/13/06) Effective Date: March 8, 2007 SUBJECT: ADVANCE DIRECTIVES
More information~ Rhode Island ~ Durable Power of Attorney For Health Care Christian Version
~ Rhode Island ~ Durable Power of Attorney For Health Care Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT You have the right to make decisions about your health care. No health care may be given
More informationA PERSONAL DECISION
A PERSONAL DECISION Practical information about determining your future medical care including declaration, powers of attorney for health care and organ donation Determining Your Medical Care is Your
More informationFORM 1 Health care power of attorney PAGE 1
FORM 1 Health care power of attorney PAGE 1 This form allows you, the principal, to name a person to make health care decisions for you if you are unable to do so. You should also name alternate agents
More informationALASKA ADVANCE HEALTH CARE DIRECTIVE for Client
ALASKA ADVANCE HEALTH CARE DIRECTIVE for Client PART 1 DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS (1) DESIGNATION OF AGENT. I designate the following individual as my agent to make health care
More informationDURABLE HEALTH CARE POWER OF ATTORNEY AND HEALTH CARE TREATMENT INSTRUCTIONS (LIVING WILL) PART I INTRODUCTORY REMARKS ON HEALTH CARE DECISION MAKING
DURABLE HEALTH CARE POWER OF ATTORNEY AND HEALTH CARE TREATMENT INSTRUCTIONS (LIVING WILL) PART I INTRODUCTORY REMARKS ON HEALTH CARE DECISION MAKING You have the right to decide the type of health care
More informationADVANCE HEALTH CARE DIRECTIVE
FORM 3-1 ADVANCE HEALTH CARE DIRECTIVE INSTRUCTIONS Part 1 of this form lets you name another individual as agent to make health care decisions for you if you become incapable of making your own decisions,
More informationAdvance Health Care Directive (California Probate Code section 4701)
Advance Health Care Directive (California Probate Code section 4701) PART 1 Power of Attorney For Health Care 1.1 DESIGNATION OF AGENT: I designate the following individual as my agent to make health care
More informationDURABLE POWER OF ATTORNEY FOR HEALTH CARE
DURABLE POWER OF ATTORNEY FOR HEALTH CARE I,, am of sound mind and I (Print or type your full name) voluntarily make this designation. APPOINTMENT OF PATIENT ADVOCATE I designate, my (Insert name of patient
More informationLOUISIANA 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
More information~ Wisconsin. Power of Attorney For Health Care Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT
~ Wisconsin ~ Power of Attorney For Health Care Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT You have the right to make decisions about your health care. No health care may be given to you over
More informationNEW HAMPSHIRE ADVANCE DIRECTIVE PAGE 4 OF 11 PART I: NEW HAMPSHIRE DURABLE POWER OF ATTORNEY FOR HEALTH CARE. I,, (name)
NEW HAMPSHIRE ADVANCE DIRECTIVE PAGE 4 OF 11 PART I: NEW HAMPSHIRE DURABLE POWER OF ATTORNEY FOR HEALTH CARE PRINT YOUR NAME PRINT THE NAME AND ADDRESS OF YOUR AGENT I,, (name) hereby appoint (name of
More informationAdvance 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
More informationDisclosure Statement for Medical Power of Attorney
Disclosure Statement for Medical Power of Attorney THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS: Except to the extent you state otherwise, this
More informationExample of A Living Will from a Catholic Perspective
Example of A Living Will from a Catholic Perspective MEDICAL POWER OF ATTORNEY, GUARDIAN APPOINTMENT, AND LIVING WILL OF -NAME- I,, of, want to participate in my own medical care as long as I am able,
More informationAdvance Directive Designation of Patient Advocate. 825 N. Center Ave Gaylord, MI MyOMH.org
Advance Directive Designation of Patient Advocate 825 N. Center Ave Gaylord, MI 49735 MyOMH.org 1084 (7/08) M:\Forms\Social Work\Advance Directive and Patient Advocate Form ADVANCE DIRECTIVE/ DESIGNATION
More informationADVANCE DIRECTIVE Planning Guide. Information Provided as a Community Service
ADVANCE DIRECTIVE Planning Guide Information Provided as a Community Service If a medical tragedy strikes, you have the RIGHT TO CHOOSE what medical care you do or do not want. It is best if you make this
More informationGEORGIA ADVANCE DIRECTIVE FOR HEALTH CARE
GEORGIA ADVANCE DIRECTIVE FOR HEALTH CARE By: Date of Birth: (Print Name) (Month/Day/Year) This advance directive for health care has four parts: PART ONE HEALTH CARE AGENT. This part allows you to choose
More information~ Arizona. Power of Attorney For Health Care Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT
~ Arizona ~ Power of Attorney For Health Care Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT You have the right to make decisions about your health care. No health care may be given to you over
More informationILLINOIS 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
More information~ Tennessee ~ Advance Directive and Appointment of Health Care Agent Christian Version WARNING TO PERSON EXECUTING THIS DOCUMENT
~ Tennessee ~ Advance Directive and Appointment of Health Care Agent Christian Version WARNING TO PERSON EXECUTING THIS DOCUMENT This is an important legal document. Before executing this document you
More informationPsychiatric Advance Directives Durable Power of Attorney for Mental Health Care
Psychiatric Advance Directives Durable Power of Attorney for Mental Health Care Revised August 2014 Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the church,
More informationPATIENT ADVOCATE DESIGNATION FOR MENTAL HEALTH TREATMENT NOTICE TO PATIENT
PATIENT ADVOCATE DESIGNATION FOR MENTAL HEALTH TREATMENT NOTICE TO PATIENT As the Patient you are using this Patient Advocate Designation for Mental Health Treatment to grant powers to another individual
More informationA PHYSICIAN S GUIDE TO ADVANCE DIRECTIVES: LIVING WILLS. Information and guidance for physicians Provided by the Illinois State Medical Society
A PHYSICIAN S GUIDE TO ADVANCE DIRECTIVES: LIVING WILLS Information and guidance for physicians Provided by the Illinois State Medical Society ILLINOIS LIVING WILL ACT Introduction The Illinois Living
More information~ Wisconsin. Power of Attorney For Health Care Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT
~ ~ Power of Attorney For Health Care Christian Version NOTICE TO PERSON MAKING THIS DOCUMENT You have the right to make decisions about your health care. No health care may be given to you over your objection,
More informationAdvance Directive Form
Advance Directive Form 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 these forms
More informationCOMPLIANCE WITH THIS PUBLICATION IS MANDATORY
BY ORDER OF THE COMMANDER 59TH MEDICAL WING 59TH MEDICAL WING INSTRUCTION 44-150 1 FEBRUARY 2017 Medical ADVANCE DIRECTIVES AND END-OF- LIFE COMPLIANCE WITH THIS PUBLICATION IS MANDATORY ACCESSIBILITY:
More informationDurable Health Care Power of Attorney and Appointment of Health Care Agent and Proxy
Durable Health Care Power of Attorney and Appointment of Health Care Agent and Proxy NOTICE TO ADULT SIGNING THIS DOCUMENT: This is an important legal document. Before executing this document, you should
More informationAdvance Health Care Directive Form Instructions
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
More informationADVANCE HEALTH CARE DIRECTIVE HEALTH CARE POWER OF ATTORNEY AND LIVING WILL
ADVANCE HEALTH CARE DIRECTIVE A HEALTH CARE POWER OF ATTORNEY AND LIVING WILL INSIDE: LEGAL DOCUMENTS AND INSTRUCTIONS TO ASSIST YOU WITH IMPORTANT HEALTH CARE DECISIONS Health Care Decision Making Modern
More informationPatient Self-Determination Act
Holy Redeemer Hospital Patient Self-Determination Act NOTES:: MAKING YOUR OWN HEALTH CARE DECISIONS: As a competent adult, you have the fundamental right, in collaboration with your health care providers,
More informationOHIO Advance Directive Planning for Important Health Care Decisions
OHIO 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, a program of the National Organization
More informationSAMPLE ADVANCE HEALTH CARE DIRECTIVE
This is a sample advance directive. Advance directives vary by state and so it is important to fill out a state-specific advance directive form. It is possible that a living will or durable power of attorney
More informationMedical Advance Directives
Chapter 24 Medical Advance Directives Michael A. Kirtland, Esq. Kirtland & Seal, L.L.C. SYNOPSIS 24-1. Living Wills 24-2. CPR Directives and DNR Orders 24-3. Medical Orders for Scope of Treatment 24-4.
More informationGeorgia Advance Directive for Healthcare
Navicent Health Georgia Advance Directive for Healthcare GEORGIA ADVANCE DIRECTIVE FOR HEALTH CARE By: Date of Birth: (Print Name) (Month/Day/Year) PART ONE HEALTH CARE AGENT This part allows you to choose
More informationMichigan: Advance Directive
Michigan: 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 these
More informationTHIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS:
Medical Power of Attorney (Part I: Disclosure Statement) THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS: Except to the extent you state otherwise,
More informationDESIGNATION OF PATIENT ADVOCATE FORM
DESIGNATION OF PATIENT ADVOCATE FORM AND DIRECTIONS for HEALTH CARE (Durable Power of Attorney for Health Care) NAME: DOB: This is an important legal document. You should discuss it with your doctor and
More informationFrequently Asked Questions for DNR
Frequently Asked Questions for DNR Q: What is Out-of-Hospital Do-Not-Resuscitate Order? A: An order that allows patients to direct health care professionals in the out-of-hospital setting to withhold or
More informationNO TALLAHASSEE, June 30, Mental Health/Substance Abuse
CFOP 155-52 STATE OF FLORIDA DEPARTMENT OF CF OPERATING PROCEDURE CHILDREN AND FAMILIES NO. 155-52 TALLAHASSEE, June 30, 2017 Mental Health/Substance Abuse USE OF DO NOT RESUSCITATE (DNR) ORDERS IN STATE
More informationREVISED 2005 EDITION. A Personal Decision
REVISED 2005 EDITION A Personal Decision Practical information about determining your future medical care, including living wills, powers of attorney for health care, mental health treatment preference
More informationINSTRUCTIONS FOR YOUR CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE
California maintains an Advance Directive Registry. By filing your advance directive with the registry, your health care provider and loved ones may be able to find a copy of your directive in the event
More informationAdvance 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
More information*1214* [1214] ADVANCE HEALTH CARE DIRECTIVE FORM 3-1 INSTRUCTIONS
FORM 3-1 ADVANCE HEALTH CARE DIRECTIVE INSTRUCTIONS Part 1 of this form lets you name another individual as agent to make health care decisions for you if you become incapable of making your own decisions,
More informationCALIFORNIA Advance Directive Planning for Important Health care Decisions
CALIFORNIA 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
More informationMISSOURI 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
More informationSUGGESTIONS FOR PREPARING WILL TO LIVE DURABLE POWER OF ATTORNEY
SUGGESTIONS FOR PREPARING WILL TO LIVE DURABLE POWER OF ATTORNEY (Please read the document itself before reading this. It will help you better understand the suggestions.) YOU ARE NOT REQUIRED TO FILL
More informationGiving Someone a Power of Attorney For Your Health Care
Giving Someone a Power of Attorney For Your Health Care A Guide with an Easy-to-Use, Legal Form for All Adults Prepared by The Commission on Law and Aging American Bar Association This publication was
More informationNote: These documents will be legally binding only if the person completing them is a competent adult (at least 18 years old).
Introduction to Your Michigan Advance Directive This packet contain the Advance Directive for Healthcare which protects your right to refuse medical treatment you do not want or to request treatment you
More informationLiving Will and Appointment of Health Care Representative (CT)
Resource ID: w-009-0161 Living Will and Appointment of Health Care Representative (CT RACHEL B.G. SHERMAN, DANIEL P. FITZGERALD, AND KATHERINE COTTER GENT, CUMMINGS & LOCKWOOD LLC WITH PRACTICAL LAW TRUSTS
More informationADVANCED HEALTH CARE DIRECTIVE OF LAWRENCE HALL JR.
ADVANCED HEALTH CARE DIRECTIVE OF LAWRENCE HALL JR. Identification. I, Lawrence Hall Jr., being a competent adult of sound mind, having the capacity to make health care decisions, willfully and voluntarily
More informationAdult: Any person eighteen years of age or older, or emancipated minor.
Advance Directives Policy and Procedure Purpose To provide an atmosphere of respect and caring and to ensure that each patient's ability and right to participate in medical decision making is maximized
More informationDURABLE POWER OF ATTORNEY FOR HEALTH CARE
DURABLE POWER OF ATTORNEY FOR HEALTH CARE I,, am of sound mind and I (Print or type your full name) voluntarily make this designation. APPOINTMENT OF PATIENT ADVOCATE I designate, my (Insert name of patient
More informationADVANCE MEDICAL DIRECTIVES
ADVANCE MEDICAL DIRECTIVES Health Care Declaration (Living Will) and Medical Power of Attorney What is an Advance Directive? Many people are concerned about what would happen if, due to a mental or physical
More informationSUGGESTIONS FOR PREPARING WILL TO LIVE DURABLE POWER OF ATTORNEY
SUGGESTIONS FOR PREPARING WILL TO LIVE DURABLE POWER OF ATTORNEY (Please read the document itself before reading this. It will help you better understand the suggestions.) YOU ARE NOT REQUIRED TO FILL
More information