Advance Directive Forms

Please let us know if you have any of the following advance directive orders:

  • A Power of Attorney for Health Care permits you, the patient, to designate an "agent" to make healthcare decisions on your behalf when you are unable to.
  • A Living Will allows you to indicate whether you want death-delaying procedures used if you have a terminal illness. A terminal illness is an incurable and irreversible condition in which death is imminent.
  • A POLST allows your physician to write an order stating what death-delaying treatments (like cardiopulmonary resuscitation (CPR)) you wish to have, if any, if your heart and/or breathing stops.

We will keep a copy of these important documents in your records.

Listen to Dr. Pedersen talk about Advance Directives on the Dial-a-Doc radio program.

Listen to Dr. Martin, FHN Chief Medical Officer, talk about Advance Directives on the Talk of the Town radio program.

Documents

English

Power of Attorney for Healthcare
Practitioner Orders for Life Sustaining Treatment (POLST) Form
Frequently Asked Questions about Advance Directives
Health Information Authorization Form

en español

Poder para la Atención de la Salud
Formulario Uniforme De Órdenes Médicas Para Tratamiento De Soporte Vital (POLST)
Preguntas frecuentes sobre directivas anticipadas
Formulario de autorización de información médica