An Advance Directive is a legal document allowing a person to give directions about future medical care or to designate another person(s) to make medical decisions if he or she should lose decision making capacity.
I understand my rights as set forth above. Please check one of the following statements:
If you do not have an Advance Directive:
If you do have an Advance Directive, please email it to [email protected]
Note: It is the patient’s responsibility to provide SHCC with a copy of any Advance Directive document (living will, health care proxy, or medical power of attorney) or other document that could affect your care, if such document(s) exist.
Patient DOB: //
Leave this empty:
If you have questions about the contents of this document, you can email the document owner.
Document Name: Advance Directive
Agree & Sign