Advance Care Planning

Talking with your family, friends and your physician about your wishes for medical care at the end of your life is called advance care planning. It's a way for you, your loved ones and your physician to discuss the kinds of care you want and don't want at that time. You can also specify the care you would want if you become unable to speak or make decisions for yourself, due to a coma or other medical condition. When you write down your wishes, this kind of plan is called an advance directive.

An Advance Health Care Directive is a legal document that tells your physician, your family members and friends about what kind of care you would like to have if you become unable to make medical decisions. It's called an advance directive because you choose your medical care before you become seriously ill.

This patient education handout, available in English and Spanish, gives information and resources on Advance Health Care Directives.
English: Advance Health Care Directive (tipsheet)
Spanish: Instrucciones adelantadas, o Poder legal duradero para el cuidado médico

Listed below are separate sections of the kit as well as the complete kit available in English and Spanish. All these documents can be downloaded separately.

An advance health care directive has 3 steps:
1. Choose a health care agent. A health care agent is someone you designate to make medical decisions for you, if at some future time, you are unable to make decisions yourself.
English: Communicate Your Health Care Wishes: Introduction to Advance Health Care Directive
Spanish: Introduccion: ¿Qué son las Disposiciones?

2. Make your own health care choices. You can have a say about how you want to be treated. This way, those who care for you will not have to guess what you want if you are too sick to tell them yourself.
English: Communicate Your Health Care Wishes: Health Care Choices Form
Spanish: Mis opciones para el cuidado medico

3. Sign the form. It must be signed before it can be used. Below are links to everything you need to complete these steps.
English: Communicate Your Health Care Wishes: California Legal Form and Instructions
Spanish: Instrucciones para completar el formulario legal

Share your agent's roles & responsibilities with him/her. Your agent has one of the most important roles that anyone can have, to fulfill a request made by you to carry out your wishes about how you want to receive care when you are no longer able to express those wishes.
English: Communicate Your Health Care Wishes: Health Care Agent Information
Spanish: Funciones y responsabilidades del representante decuidado de médico

Advance Health Care Directive Entire Kit
English: Communicate Your Health Care Wishes: Advance Health Care Directive (large download)
Spanish: Comunique Sus Deseos Su Atencion Medica (large download)

Out-of-Hospital Do-Not-Resuscitate (DNR) Program
This program allows you to decide if you do not want to be resuscitated if you stop breathing and your heart stops beating. It allows you to declare that certain resuscitative measures will not be used on you in a pre-hospital setting. The handout below contains the Form and instructions on filling out the form.
Prehospital Do Not Resuscitate (DNR) Form

MedicAlert Bracelet and Information
You can link your DNR Form to a MedicAlert bracelet or emblem. These are recognized by emergency responders.

Order Form for a DNR Bracelet or Medallion

POLST FORM – Physician Orders for Life-Sustaining Treatment – The POLST is a doctor’s order that indicates what types of life-sustaining treatment you do or do not want if you become seriously ill. The POLST will take the place of the older "out of hospital DNR" form.

Completing a POLST is voluntary.

The POLST does not replace the Advance Health Care Directive. The Advance Directive largely identifies a surrogate decision-maker should you become unable to make decisions about your health care. The POLST is intended to help you and your doctor discuss and develop specific plans to reflect your wishes. It also helps doctors , other health professionals and emergency personnel honor your wishes for life-sustaining treatment, especially in an emergency. The POLST is designed to be an adjunct to an Advance Directive.

The POLST form remains with you if you are moved between care settings, regardless of whether you are in the hospital, at home or in a long-term care facility. If you live at home, keep the original POLST form where emergency responders can find it.

The POLST form, which you and your doctor will sign, will be printed on bright pink paper.

Physician Orders for Life-Sustaining Treatment (POLST)

End of Life Care
Decisions about End-of-Life Care

Hospice Care
Additional resources and information on advance care planning and end-of-life care.

Disclaimer
If you think you have a MEDICAL OR PSYCHIATRIC EMERGENCY, CALL 911 IMMEDIATELY or go to the nearest hospital. DO NOT attempt to access emergency care through this web site. An emergency medical condition is a medical or psychiatric condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in any of the following: serious jeopardy to your health, serious impairment to your bodily functions, or serious dysfunction of any bodily organ or part. An emergency medical condition is also "active labor," which means a labor when there is inadequate time for safe transfer to a Plan hospital (or designated hospital) before delivery or if a transfer poses a threat to the health of the member or unborn child.

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