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
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 driverŐs 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