Name an agent to make health care decisions
for
you if you become incapable of making your own decisions.
Section I of the form allows you name another individual as
an agent to make health care decisions for you if you can no longer
make your own decisions. You may also name an alternate agent.
This section of the form is called a Power of Attorney for Health
Care.
Give instructions about your own health
care.
Section II of the advance directive form lets you give
specific instructions about health care decisions. Choices are
provided for you to express your wishes regarding the provision,
withholding, or withdrawal of treatment to keep you alive if you
have a terminal medical condition or if you become permanently
unconscious, including the provision of artificial nutrition and
hydration as well as the provision of pain relief. Space
is provided for you to write additional health care instructions.
Section III allows you to designate the name of your primary physician.
Express an intention to donate bodily organs
and/or tissue following your death.
Section IV of the form is optional. It allows you, if
you wish, to designate anatomical gifts to take effect upon your
death.