Print an Advance Directive

Print an Advance Directive ~ English

Print an Advance Directive ~ Spanish

PDF files can be viewed with Adobe Acrobat Reader.

What to do with this Advance Care Plan Document:

• Always keep your original document. Put it with your personal files where it is accessible to others.
• Give a copy to your physician(s).
• Take a copy to the hospital each and every time you are admitted.
• Give a copy to your designated Health Care Surrogate, explain the meaning and purpose of your Advance Care Plan to your surrogate, and have an in-depth discussion about your goals of care and wishes at end-of-life.

• Tell your closest relatives what is in the Advance Care Plan document.

• Give a copy to your Spiritual Leader.
• If you have a pre-existing Living Will or Advance Care Plan, destroy the old document and any existing copies and give copies of your new document to the above individuals.
• Some States require an additional form to be completed if you do not want cardiopulmonary resuscitation (CPR) attempted. You should check with your health care provider or State health officials to find out if your State requires an additional form to prevent unwanted CPR (Do Not Attempt Resuscitation Form or "DNR" form).
• If you feel this document is useful to you, share the idea with friends and relatives and refer them to Project GRACE for further information and their own Advance Care Plan.

"One important ingredient of the medical profession is a firm commitment to the patient not to abandon them until the end. It is what makes medicine such a great profession; Filled with joy and sorrow, exhilaration and sadness, but always compassionate, caring and altruistic. Its moral authority derives from the fact that the patients' well-being is paramount from beginning to end." -Lofty Basta, M.D., A GRACEful Exit

Copyright waived for individual use and downloading. The printed version form is valid. If you wish an original form, please contact Project GRACE.