Purpose:
States ones wishes about medical care in the event that one develops a terminal or irreversible condition and can no longer make medical decisions.
Notes:
- Becomes effective when the attending physician certifies in writing that one is in a terminal or irreversible condition.
- Copies are legal, so make plenty so that it is available when needed.
- Provide a copy of this document to your physician, usual hospital and family or spokesperson.
- Consider a periodic review of this document. By periodic review, you can best assure that the directive reflects your preferences.
- Commonly known as a Do Not Resuscitate Order (DNR).
- This document is a requirement if on hospice care.
- Allows for you to list particular treatments that you do or do not want in specific circumstances.
- Requires 2 witnesses.
Download the template:
Directive to Physicians and Family or Surrogates