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Personal Crisis Plan (Advance Directive)

Personal Crisis plan ( advance directive ) (To be used if the circumstances described on page 2 of this document occur.) Name _____ Date _____ Part 1 What I m like when I m feeling well. _____ _____ _____ Copyright by Mary Ellen Copeland, PO Box 301, W. Dummerston, VT 05357 Phone: (802) 254- 2092 e- mail: Website: All rights reserved Wellness Recovery Action plan and WRAP are registered trademarks. Part 2 Signs I Need My Supporters to Take Over If I have several of the following signs and/or symptoms, my supporters, named on the next page, need to take over responsibility for my care and make decisions in my behalf based on the information in this plan .

Title: Microsoft Word - Crisis Plan 2012 Manual.docx Author: Magdaline Volaitis Created Date: 6/19/2012 9:45:48 PM

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