SAMPLE - Five Wishes
Health Care Agent (or other term that may be used in my state, such as proxy, representative, or surrogate). This person will make my health care choices if both of these things happen: • My attending or treating doctor finds I am no longer able to make health care choices, AND • Another health care professional agrees that this is true.
Download SAMPLE - Five Wishes
Information
Domain:
Source:
Link to this page:
Related documents
Advance Care Planning: Ensuring Your Wishes Are Known and ...
www.cdc.govOnly 28 percent of home health care patients, 65 percent of nursing home residents and 88 percent of hospice care patients have an advance directive on record (Jones 2011). Even among severely or terminally ill patients, fewer than 50 percent had an advance directive in their medical record (Kass-Bartelmes 2003).
Special Events Contingency Planning
training.fema.govsafety (including security, public health, and medical care). Historically, advance assessment of and planning for an event failed to occur, or when they did, they failed to identify the potential for disaster or mitigating or coping strategies in the event of a major incident.
Indiana Advance Health Care Directive
prepareforyourcare.orgIndiana Advance Health Care Directive hi r let have a a at h ant t e cared r i cannt ea r rel Your Name 1 TM Developed by for your care www.prepareforyourcare.org You can fill out Part 1, Part 2, or both. Fill out only the parts you want. Always sign the form in Part 3.
ADVANCE DIRECTIVES
www.in.govChoosing a health care representative is part of the Indiana Health Care Consent Act, found at Indiana Code § 16 -36 -1. The advance directive naming a health care representative must be in writing, signed by you, and witnessed by another adult. Because these are serious decisions, your health care representative must make them