Advanced Health Care Directive Checklist

o Talk with family members, friends, spiritual advisors, physicians, other health-care providers and other trusted persons about what would be important to you if you become terminally or irreversibly ill or injured and you can no longer communicate your health-care decisions or other wishes.

o Ask someone you trust and whom you can count on to be your health-care agent and discuss your wishes with this person. Select an alternate health-care agent in case your agent is unable to serve.

o Complete either one of the enclosed simplified forms, change or cross out provisions or make an entirely different document. Add pages if you like.

o Have two qualified witnesses or a notary witness your signature.

o Inform family members, spouse, parents, children, siblings, friends, physicians and othe rhealth-care providers that you have executed an advance health-care directive and that you expect them to honor your instructions. Keep them informed about your current wishes.

o Give copies of the document to your health-care agent, health-care providers, family, close friends, clergy or any other individuals who might be involved in caring for you.

o Place the executed document in your medical files.

o When you renew your driver’s license or state I.D, you may designate that you have an advance directive by putting (AHCD) on it.

o Make plans to review the document on a regular basis—make a new document, if necessary, and keep people informed of any changes.

o Do it today!