Medical Directive Template

If you wish to only use the medical power of attorney strike an x through this section.

Medical directive template. The statutory advance health care directive form is as follows. To the extent my wishes are unknown my agent. Advance health care directive forms 4700 4701 chapter 2 added by stats. The following diagram identifies the types of templates that are available and the use of each step.

Directives an advance directive can be used to name a health care agent. The state offers a form to do this planning inclu ded with this pamphlet. Advance directive is the general term that refers to the various documents that could include a living will instruction directive health care proxy or health care power of attorney. On the physician order sheet in the patients health care record the specific medical directive time and date of implementation and the signature of the.

Decisions about personal care involve things such as where one lives what one. Documentation of all delegation is highly recommended. In certain circumstances wherein a patient cannot communicate their decision due to being physically or mentally incapable a health care directive form is given in advance. Annas jd mph writing in an article published online by the new england journal of medicine on march 22 2005.

A medical directive must be in writing. Step 2 health care directive. For health care any instructions i give in part 2 of this form and my other wishes to the extent known to my agent. A personal directive or health care directive or power of attorney for personal care allows someone the maker to give a person of their choice the authority to make decisions about their personal care should they become mentally incapable and to give directions to their health care providers about health care.

There is however a growing movement towards the. The registered dietitian implementing the medical directive will document herhis actions on the patients health record in accordance with the college of dietitians of ontario guidelines. Here is an example of an advance medical directive. An advance directive through a living will or the designation of a health care proxy prevents the involvement of the courts in virtually all cases according to george j.

In our example we are using the living will as seen below. This document combines a health care directive which is your living will along with a medical power of attorney to appoint an agent. Step 3 life support. A health care directive is a document where the patients writes down their wishes regarding their treatment and health care.

This is someone you trust to make health care decisions for you. In order to complete an advance health care directive you must identify the types of treatments you do and do not want at the end of your life living will and name someone who will make sure that your health care decisions are followed health care proxy or health care power of attorneyevery state has its own advance directive forms.