What Is an Advance Directive?

An advance directive is a legal document that explains how you want medical decisions about you to be made if you cannot make the decisions yourself. An advance directive lets your health care team and loved ones know what kind of health care you want, or who you want to make decisions for you when you can’t. An advance directive can help you think ahead of time about what kind of care you want. It may help guide your loved ones and health care team in making clear decisions about your health care when you can’t do it yourself.

An advance directive is meant to help you plan ahead and let others know what kind of care you want. It is used to guide your loved ones and health care team in making clear decisions about your health care if you can’t make medical decisions by yourself. These medical decisions may include special actions or emergency care from your health care team.

Advance directives only apply to health care decisions and do not affect financial or money matters. The laws around advance directives are different from state to state. Talk to your health care provider (or your lawyer) about filling out your advance directive when you are still healthy, in case you become too ill or are unable to make medical decisions for yourself in the future.

The Patient Self-Determination Act

The 1990 Patient Self-Determination Act (PSDA) encourages everyone to decide ahead of time about the types and extent of medical care they want to accept or refuse if they become unable to make those decisions due to illness.

The PSDA requires hospitals, skilled nursing facilities, home health agencies, hospice programs, and Health Maintenance Organizations (HMOs):

• To give patients information on their state laws about their rights to make decisions about their care.
• To find out if patients have an advance directive.
• To recognize the advance directive and honor the patient’s wishes.
• To never discriminate against patients based on whether they have filled out an advance directive or not.

Health care facilities can’t require patients to have advance directives: It is the patient’s choice.

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Living wills and advance directives for medical decisions

Living wills and advance directives for medical decisions

Plan ahead and get the medical care you want at the end of life.

By Mayo Clinic Staff

Living wills and other advance directives are written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. Advance directives guide choices for doctors and caregivers if you’re terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.

Advance directives aren’t just for older adults. Unexpected end-of-life situations can happen at any age, so it’s important for all adults to prepare these documents.

By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf.

Power of attorney

A medical or health care power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. In some states this directive may also be called a durable power of attorney for health care or a health care proxy.

Depending on where you live, the person you choose to make decisions on your behalf may be called one of the following:

• Health care agent
• Health care proxy
• Health care surrogate
• Health care representative
• Health care attorney-in-fact
• Patient advocate

Choosing a person to act as your health care agent is important. Even if you have other legal documents regarding your care, not all situations can be anticipated and some situations will require someone to make a judgment about your likely care wishes. You should choose a person who meets the following criteria:

• Meets your state’s requirements for a health care agent
• Is not your doctor or a part of your medical care team
• Is willing and able to discuss medical care and end-of-life issues with you
• Can be trusted to make decisions that adhere to your wishes and values
• Can be trusted to be your advocate if there are disagreements about your care

The person you name may be a spouse, other family member, friend or member of a faith community. You may also choose one or more alternates in case the person you chose is unable to fulfill the role.

Living will

A living will is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as your preferences for other medical decisions, such as pain management or organ donation.

In determining your wishes, think about your values. Consider how important it is to you to be independent and self-sufficient, and identify what circumstances might make you feel like your life is not worth living. Would you want treatment to extend your life in any situation? All situations? Would you want treatment only if a cure is possible?

You should address a number of possible end-of-life care decisions in your living will. Talk to your doctor if you have questions about any of the following medical decisions:

• Cardiopulmonary resuscitation (CPR) restarts the heart when it has stopped beating. Determine if and when you would want to be resuscitated by CPR or by a device that delivers an electric shock to stimulate the heart.
• Mechanical ventilation takes over your breathing if you’re unable to breathe on your own. Consider if, when and for how long you would want to be placed on a mechanical ventilator.
• Tube feeding supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when and for how long you would want to be fed in this manner.
• Dialysis removes waste from your blood and manages fluid levels if your kidneys no longer function. Determine if, when and for how long you would want to receive this treatment.
• Antibiotics or antiviral medications can be used to treat many infections. If you were near the end of life, would you want infections to be treated aggressively or would you rather let infections run their course?
• Comfort care (palliative care) includes any number of interventions that may be used to keep you comfortable and manage pain while abiding by your other treatment wishes. This may include being allowed to die at home, getting pain medications, being fed ice chips to soothe mouth dryness, and avoiding invasive tests or treatments.
• Organ and tissue donations for transplantation can be specified in your living will. If your organs are removed for donation, you will be kept on life-sustaining treatment temporarily until the procedure is complete. To help your health care agent avoid any confusion, you may want to state in your living will that you understand the need for this temporary intervention.
• Donating your body for scientific study also can be specified. Contact a local medical school, university or donation program for information on how to register for a planned donation for research.

Do not resuscitate and do not intubate orders

You don’t need to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. To establish DNR or DNI orders, tell your doctor about your preferences. He or she will write the orders and put them in your medical record.

Even if you already have a living will that includes your preferences regarding resuscitation and intubation, it is still a good idea to establish DNR or DNI orders each time you are admitted to a new hospital or health care facility.

Creating advance directives

Advance directives need to be in writing. Each state has different forms and requirements for creating legal documents. Depending on where you live, a form may need to be signed by a witness or notarized. You can ask a lawyer to help you with the process, but it is generally not necessary.

Links to state-specific forms can be found on the websites of various organizations such as the American Bar Association, AARP and the National Hospice and Palliative Care Organization.

Review your advance directives with your doctor and your health care agent to be sure you have filled out forms correctly. When you have completed your documents, you need to do the following:

• Keep the originals in a safe but easily accessible place.
• Give a copy to your doctor.
• Give a copy to your health care agent and any alternate agents.
• Keep a record of who has your advance directives.
• Talk to family members and other important people in your life about your advance directives and your health care wishes. By having these conversations now, you help ensure that your family members clearly understand your wishes. Having a clear understanding of your preferences can help your family members avoid conflict and feelings of guilt.
• Carry a wallet-sized card that indicates you have advance directives, identifies your health care agent and states where a copy of your directives can be found.
• Keep a copy with you when you are traveling.

Reviewing and changing advance directives

You can change your directives at any time. If you want to make changes, you must create a new form, distribute new copies and destroy all old copies. Specific requirements for changing directives may vary by state.

You should discuss changes with your primary care doctor and make sure a new directive replaces an old directive in your medical file. New directives must also be added to medical charts in a hospital or nursing home. Also, talk to your health care agent, family and friends about changes you have made.

Consider reviewing your directives and creating new ones in the following situations:

• New diagnosis. A diagnosis of a disease that is terminal or that significantly alters your life may lead you to make changes in your living will. Discuss with your doctor the kind of treatment and care decisions that might be made during the expected course of the disease.
• Change of marital status. When you marry, divorce, become separated or are widowed, you may need to select a new health care agent.
• About every 10 years. Over time your thoughts about end-of-life care may change. Review your directives from time to time to be sure they reflect your current values and wishes.

Physician orders for life-sustaining treatment (POLST)

In some states, advance health care planning includes a document called physician orders for life-sustaining treatment (POLST). The document may also be called provider orders for life-sustaining treatment (POLST) or medical orders for life-sustaining treatment (MOLST).

A POLST is intended for people who have already been diagnosed with a serious illness. This form does not replace your other directives. Instead, it serves as doctor-ordered instructions — not unlike a prescription — to ensure that, in case of an emergency, you receive the treatment you prefer. Your doctor will fill out the form based on the contents of your advance directives, the discussions you have with your doctor about the likely course of your illness and your treatment preferences.

A POLST stays with you. If you are in a hospital or nursing home, the document is posted near your bed. If you are living at home or in a hospice care facility, the document is prominently displayed where emergency personnel or other medical team members can easily find it.

Forms vary by state, but essentially a POLST enables your doctor to include details about what treatments not to use, under what conditions certain treatments can be used, how long treatments may be used and when treatments should be withdrawn. Issues covered in a POLST may include:

• Resuscitation
• Mechanical ventilation
• Tube feeding
• Use of antibiotics
• Requests not to transfer to an emergency room
• Requests not to be admitted to the hospital
• Pain management

A POLST also indicates what advance directives you have created and who serves as your health care agent. Like advance directives, POLSTs can be canceled or updated.

Aug. 22, 2020

Show references

1. AskMayoExpert. Advance directives. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
2. AskMayoExpert. Do not resuscitate/do not intubate order. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
3. Advance care planning: Healthcare directives. National Institute on Aging. https://www.nia.nih.gov/health/advance-care-planning-healthcare-directives. Accessed Nov. 17, 2018.
4. Give peace of mind: Advance care planning. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/advancecareplanning/. Accessed Nov. 17, 2018.
5. Frequently asked questions: Advance directives. American Cancer Society. https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/advance-directives/faqs. html. Accessed Nov. 19, 2018.
6. Toolkit for health care advance planning. American Bar Association. https://www.americanbar.org/groups/law_aging/resources/health_care_decision_making/consumer_s_toolkit_for_health_care_advance_planning.html. Accessed Oct. 2, 2018.
7. Myths and facts about health care advance directives. American Bar Association. https://www.americanbar.org/publications/bifocal/vol_37/issue_1_october2015/myths_and_facts_advance_directives.html. Accessed Oct. 2, 2018.
8. Living wills, health care proxies, & advance health care directives. American Bar Association. https://www.americanbar.org/groups/real_property_trust_estate/resources/estate_planning/living_wills_health_care_proxies_advance_health_care_directives.html. Accessed Oct. 2, 2018.
9. POLST for professionals. National POLST Paradigm. http://polst.org/professionals-page/?pro=1. Accessed Nov. 19, 2018.
10. Patient FAQs. National POLST Paradigm. http://polst.org/faq/?pro=1. Accessed Nov. 19, 2018.

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Advance Care Planning: Health Care Directives

Advance care planning is not just about old age. At any age, a medical crisis could leave you too ill to make your own health care decisions. Even if you are not sick now, planning for health care in the future is an important step toward making sure you get the medical care you would want, if you are unable to speak for yourself and doctors and family members are making the decisions for you.

Many Americans face questions about medical treatment but may not be capable of making those decisions, for example, in an emergency or at the end of life. This article will explain the types of decisions that may need to be made in such cases and questions you can think about now so you’re prepared later. It can help you think about who you would want to make decisions for you if you can’t make them yourself. It will also discuss ways you can share your wishes with others. Knowing who you want to make decisions on your behalf and how you would decide might take some of the burden off family and friends.

What Is Advance Care Planning?

Advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know—both your family and your health care providers—about your preferences. These preferences are often put into an advance directive, a legal document that goes into effect only if you are incapacitated and unable to speak for yourself. This could be the result of disease or severe injury—no matter how old you are. It helps others know what type of medical care you want.

An advance directive also allows you to express your values and desires related to end-of-life care. You might think of it as a living document—one that you can adjust as your situation changes because of new information or a change in your health.

Research shows that advance directives can make a difference, and that people who document their preferences in this way are more likely to get the care they prefer at the end of life than people who do not.

Advance Care Planning Decisions

Sometimes decisions must be made about the use of emergency treatments to keep you alive. Doctors can use several artificial or mechanical ways to try to do this. Decisions that might come up at this time relate to:

• CPR (cardiopulmonary resuscitation)
• Ventilator use
• Artificial nutrition (tube feeding) and artificial hydration (IV, or intravenous, fluids)
• Comfort care

What is CPR? Cardiopulmonary resuscitation might restore your heartbeat if your heart stops or is in a life-threatening abnormal rhythm. It involves repeatedly pushing on the chest with force, while putting air into the lungs. This force has to be quite strong, and sometimes ribs are broken or a lung collapses. Electric shocks, known as defibrillation, and medicines might also be used as part of the process. The heart of a young, otherwise healthy person might resume beating normally after CPR. Often, CPR does not succeed in older adults who have multiple chronic illnesses or who are already frail.

Using a ventilator as emergency treatment. Ventilators are machines that help you breathe. A tube connected to the ventilator is put through the throat into the trachea (windpipe) so the machine can force air into the lungs. Putting the tube down the throat is called intubation. Because the tube is uncomfortable, medicines are often used to keep you sedated while on a ventilator. If you are expected to remain on a ventilator for a long time, a doctor may perform a tracheotomy or “trach” (rhymes with “make”). During this bedside surgery, the tube is inserted directly into the trachea through a hole in the neck. For long-term help with breathing, a trach is more comfortable, and sedation is not needed. People using such a breathing tube are not able to speak without special help because exhaled air does not go past their vocal cords.

Using artificial nutrition and hydration near the end of life. If you are not able to eat, you may be fed through a feeding tube that is threaded through the nose down to your stomach. If tube feeding is still needed for an extended period, a feeding tube may be surgically inserted directly into your stomach. Hand feeding (sometimes called assisted oral feeding) is an alternative to tube feeding. This approach may have fewer risks, especially for people with dementia.

If you are not able to drink, you may be provided with IV fluids. These are delivered through a thin plastic tube inserted into a vein.

Artificial nutrition and hydration can be helpful if you are recovering from an illness. However, studies have shown that artificial nutrition toward the end of life does not meaningfully prolong life. Artificial nutrition and hydration may also be harmful if the dying body cannot use the nutrition properly.

What is comfort care at the end of life? Comfort care is anything that can be done to soothe you and relieve suffering while staying in line with your wishes. Comfort care includes managing shortness of breath; limiting medical testing; providing spiritual and emotional counseling; and giving medication for pain, anxiety, nausea, or constipation.

Learn more about hospice care and other health care decisions you may need to make at the end of life.

Getting Started with Advance Care Planning

Share this infographic to spread advance care planning tips to help get your affairs in order.

Start by thinking about what kind of treatment you do or do not want in a medical emergency. It might help to talk with your doctor about how your current health conditions might influence your health in the future. For example, what decisions would you or your family face if your high blood pressure leads to a stroke? You can ask your doctor to help you understand and think through your choices before you put them in writing. Discussing advance care planning decisions with your doctor is free through Medicare during your annual wellness visit. Private health insurance may also cover these discussions.

If you don’t have any medical issues now, your family medical history might be a clue to help you think about the future. Talk with your doctor about decisions that might come up if you develop health problems similar to those of other family members.

In considering treatment decisions, your personal values are key. Is your main desire to have the most days of life? Or, would your focus be on quality of life, as you see it? What if an illness leaves you paralyzed or in a permanent coma and you need to be on a ventilator? Would you want that?

What makes life meaningful to you? If your heart stops or you have trouble breathing, would you want to undergo life-saving measures if it meant that, in the future, you could be well enough to spend time with your family? Would you be content if the emergency leaves you simply able to spend your days listening to books on tape or gazing out the window?

But, there are many other scenarios. Here are a few. What would you decide?

• If a stroke leaves you unable to move and then your heart stops, would you want CPR? What if you were also mentally impaired by a stroke—does your decision change?
• What if you are in pain at the end of life? Do you want medication to treat the pain, even if it will make you more drowsy and lethargic?
• What if you are permanently unconscious and then develop pneumonia? Would you want antibiotics and to be placed on a ventilator?

For some people, staying alive as long as medically possible, or long enough to see an important event like a grandchild’s wedding, is the most important thing. An advance directive can help to make that possible. Others have a clear idea about when they would no longer want to prolong their life. An advance directive can help with that, too.

Your decisions about how to handle any of these situations could be different at age 40 than at age 85. Or, they could be different if you have an incurable condition as opposed to being generally healthy. An advance directive allows you to provide instructions for these types of situations and then to change the instructions as you get older or if your viewpoint changes.

Many people are unprepared to deal with the legal and financial consequences of a serious illness such as Alzheimer’s disease. Advance planning can help people with Alzheimer’s and their families clarify their wishes and make well-informed decisions about health care and financial arrangements.

Learn more about legal and financial planning for people with Alzheimer’s disease.

Making Your Advance Care Wishes Known

There are two main elements in an advance directive—a living will and a durable power of attorney for health care. There are also other documents that can supplement your advance directive. You can choose which documents to create, depending on how you want decisions to be made. These documents include:

• Living will
• Durable power of attorney for health care
• Other advance care planning documents

Living will. A living will is a written document that helps you tell doctors how you want to be treated if you are dying or permanently unconscious and cannot make your own decisions about emergency treatment. In a living will, you can say which of the procedures described in the Decisions That Could Come Up section you would want, which ones you wouldn’t want, and under which conditions each of your choices applies.

Durable power of attorney for health care. A durable power of attorney for health care is a legal document naming a health care proxy, someone to make medical decisions for you at times when you are unable to do so. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. This means that he or she will be able to decide as you would when treatment decisions need to be made. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, like a serious auto accident.

Some people are reluctant to put specific health decisions in writing. For them, naming a health care agent might be a good approach, especially if there is someone they feel comfortable talking with about their values and preferences. A named proxy can evaluate each situation or treatment option independently.

Other advance care planning documents. You might also want to prepare documents to express your wishes about a single medical issue or something not already covered in your advance directive. A living will usually covers only the specific life-sustaining treatments discussed earlier. You might want to give your health care proxy specific instructions about other issues, such as blood transfusion or kidney dialysis. This is especially important if your doctor suggests that, given your health condition, such treatments might be needed in the future.

Medical issues that might arise at the end of life include:

• DNR orders
• Organ and tissue donation
• POLST and MOLST forms

A DNR (do not resuscitate) order tells medical staff in a hospital or nursing facility that you do not want them to try to return your heart to a normal rhythm if it stops or is beating unsustainably using CPR or other life-support measures. Sometimes this document is referred to as a DNAR (do not attempt resuscitation) or an AND (allow natural death) order. Even though a living will might say CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your bed might avoid confusion in an emergency situation. Without a DNR order, medical staff will make every effort to restore your breathing and the normal rhythm of your heart.

A similar document, called a DNI (do not intubate) order, tells medical staff in a hospital or nursing facility that you do not want to be put on a breathing machine.

A non-hospital DNR order will alert emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in the hospital.

Organ and tissue donation allow organs or body parts from a generally healthy person who has died to be transplanted into people who need them. Commonly, the heart, lungs, pancreas, kidneys, corneas, liver, and skin are donated. There is no age limit for organ and tissue donation. You can carry a donation card in your wallet. Some states allow you to add this decision to your driver’s license. Some people also include organ donation in their advance care planning documents.

At the time of death, family members may be asked about organ donation. If those close to you, especially your proxy, know how you feel about organ donation, they will be ready to respond. There is no cost to the donor’s family for this gift of life. If the person has requested a DNR order but wants to donate organs, he or she might have to indicate that the desire to donate supersedes the DNR. That is because it might be necessary to use machines to keep the heart beating until the medical staff is ready to remove the donated organs.

Learn more about organ and tissue donation.

Brain donation is different from other organ donation in that the brain is donated to scientific research. By studying the brains of people who have died — both those who had a brain disorder and those who were healthy during life — researchers learn more about how particular diseases affect the brain and how we might better treat and prevent them.

Learn more about brain donation.

POLST and MOLST forms provide guidance about your medical care preferences in the form of a doctor’s orders. Typically you create a POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) when you are near the end of life or critically ill and know the specific decisions that might need to be made on your behalf. These forms serve as a medical order in addition to your advance directive. They make it possible for you to provide guidance that health care professionals can act on immediately in an emergency.

A number of states use POLST and MOLST forms, which are filled out by your doctor or sometimes by a nurse practitioner or physician’s assistant. The doctor fills out a POLST or MOLST after discussing your wishes with you and your family. Once signed by your doctor, this form has the same authority as any other medical order. Check with your state department of health to find out if these forms are available where you live.

Some people have pacemakers to help their hearts beat regularly. If you have one and are near death, it may not necessarily keep you alive. But, you might have an ICD (implantable cardioverter-defibrillator) placed under your skin to shock your heart back into regular beatings if the rhythm becomes irregular. If you decline other life-sustaining measures, the ICD may be turned off. You need to state in your advance directive what you want done if the doctor suggests it is time to turn it off.

How to Choose Your Health Care Proxy

If you decide to choose a proxy, think about people you know who share your views and values about life and medical decisions. Your proxy might be a family member, a friend, your lawyer, or someone in your social or spiritual community. It’s a good idea to also name an alternate proxy. It is especially important to have a detailed living will if you choose not to name a proxy.

You can decide how much authority your proxy has over your medical care—whether he or she is entitled to make a wide range of decisions or only a few specific ones. Try not to include guidelines that make it impossible for the proxy to fulfill his or her duties. For example, it’s probably not unusual for someone to say in conversation, “I don’t want to go to a nursing home,” but think carefully about whether you want a restriction like that in your advance directive. Sometimes, for financial or medical reasons, that may be the best choice for you.

Of course, check with those you choose as your health care proxy and alternate before you name them officially. Make sure they are comfortable with this responsibility.

Making Your Health Care Directives Official

Once you have talked with your doctor and have an idea of the types of decisions that could come up in the future and whom you would like as a proxy, if you want one at all, the next step is to fill out the legal forms detailing your wishes. A lawyer can help but is not required. If you decide to use a lawyer, don’t depend on him or her to help you understand different medical treatments. Start the planning process by talking with your doctor.

Many states have their own advance directive forms. Your local Area Agency on Aging can help you locate the right forms. You can find your area agency phone number by calling the Eldercare Locator toll-free at 1-800-677-1116 or by visiting https://eldercare.acl.gov.

Some states require your advance directive to be witnessed; a few require your signature to be notarized. A notary is a person licensed by the state to witness signatures. You might find a notary at your bank, post office, or local library, or call your insurance agent. Some notaries charge a fee.

Some states have registries that can store your advance directive for quick access by health care providers, your proxy, and anyone else to whom you have given permission. Private firms also will store your advance directive. There may be a fee for storing your form in a registry. If you store your advance directive in a registry and later make changes, you must replace the original with the updated version in the registry.

Some people spend a lot of time in more than one state—for example, visiting children and grandchildren. If that’s your situation, consider preparing an advance directive using forms for each state—and keep a copy in each place, too.

What to Do After You Set Up Your Advance Directive

Give copies of your advance directive to your health care proxy and alternate proxy. Give your doctor a copy for your medical records. Tell close family members and friends where you keep a copy. If you have to go to the hospital, give staff there a copy to include in your records. Because you might change your advance directive in the future, it’s a good idea to keep track of who receives a copy.

Review your advance care planning decisions from time to time—for example, every 10 years, if not more often. You might want to revise your preferences for care if your situation or your health changes. Or, you might want to make adjustments if you receive a serious diagnosis; if you get married, separated, or divorced; if your spouse dies; or if something happens to your proxy or alternate. If your preferences change, you will want to make sure your doctor, proxy, and family know about them.

It can be helpful to have conversations with the people close to you about how you want to be cared for in a medical emergency or at the end of life. These talks can help you think through the wishes you want to put in your advance directive.

It’s especially helpful to talk about your thoughts, beliefs, and values with your health care proxy. This will help prepare him or her to make medical decisions that best reflect your values.

After you have completed your advance directive, talk about your decisions with your health care proxy, loved ones, and your doctor to explain what you have decided. This way, they are not surprised by your wishes if there is an emergency.

Another way to convey your wishes is to make a video of yourself talking about them. This lets you express your wishes in your own words. Videos do not replace an advance directive, but they can be helpful for your health care proxy and your loved ones.

Be Prepared

What happens if you have no advance directive or have made no plans and you become unable to speak for yourself? In such cases, the state where you live will assign someone to make medical decisions on your behalf. This will probably be your spouse, your parents if they are available, or your children if they are adults. If you have no family members, the state will choose someone to represent your best interests.

Always remember: an advance directive is only used if you are in danger of dying and need certain emergency or special measures to keep you alive, but you are not able to make those decisions on your own. An advance directive allows you to make your wishes about medical treatment known.

It is difficult to predict the future with certainty. You may never face a medical situation where you are unable to speak for yourself and make your wishes known. But having an advance directive may give you and those close to you some peace of mind.

You might want to make a card to carry in your wallet indicating that you have an advance directive and where it is kept. Here is an example of the wallet card offered by the American Hospital Association. You might want to print this to fill out and carry with you. A PDF can be found online (PDF, 40 KB).

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Health Care Directives

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
January 15, 2018

What Is Advanced Directive for Health Car (Living Will)? – Oklahoma Bar Association

Q: What is an Advance Directive for Health Care?

A: An Advance Directive for Health Care is a written legal document which allows you to instruct your attending physician whether or not you wish to be given life-sustaining treatments and artificially administered nutrition (food) and hydration (water) and to give other medical directions that impact the end of life. Its purpose is to recognize your right to control some aspects of your medical care and treatment, primarily the right to decline medical treatment or direct that it be withdrawn even if death ensues. An Advance Directive for Health Care may include a living will, the appointment of a health care proxy (a proxy is a person authorized to act for another) and directions for organ donation.

Q: Who can sign an Advance Directive for Health Care?

A: Any person of sound mind who is 18 or older.

Q: Does the signing of an Advance Directive require witnesses and a notary public?

A: An Advance Directive must be signed before two witnesses who are 18 or older. The witnesses cannot be beneficiaries under your will, nor may they be persons who would inherit your property if you died without a will. An Advance Directive is not required to be notarized.

Q: When does an Advance Directive go into effect?

A: An Advance Directive goes into effect when your attending physician and another physician determine that you are no longer able to make decisions regarding your medical treatment and you are in one of the three conditions explained on next page. Advance Directives do not determine your medical treatment in situations that do not affect your continued life, such as routine medical treatment and non life-threatening medical conditions.

Q: What conditions does an Advance Directive cover?

A: An Advance Directive covers three conditions: 1) terminal condition, 2) persistently unconscious and 3) end-stage condition.

Q: What does “terminal condition” mean?

A: A terminal condition is an incurable, irreversible condition that, even with the administration of life-sustaining treatment (such as putting a person on a respirator, dialysis, pacemakers, surgery, blood transfusions and antibiotics) will, in the opinion of your attending physician and another physician, result in death within six months.

Q: What does the term “persistently unconscious” mean?

A: “Persistently unconscious” means an irreversible condition as determined by your attending physician and another physician, in which thought and awareness of self and environment are absent.

Q: What is an “end-stage condition”?

A: An “end-stage condition” means a condition caused by injury, disease or illness which results in severe and permanent deterioration indicated by incompetency and complete physical dependency for which treatment of the irreversible condition would be medically ineffective.

Q: What is the living will portion of an Advance Directive?

A: In the living will portion of your Advance Directive (Section I) you may direct that your life not be extended by life-sustaining treatment if you 1) are in a terminal condition, 2) are persistently unconscious or 3) have an end-stage condition. Alternatively, you can direct that you are to be given life-sustaining treatment if you are in any of those three conditions.

You also have the ability to direct whether or not you wish to receive artificially administered nutrition (food) and hydration (water) if you are unable to take food and water by mouth in each of the three conditions described. Artificially administered food and water normally involves the surgical insertion of a feeding tube into your stomach.

Oklahoma law does provide that even if life-sustaining treatment or artificially administered nutrition and hydration are withheld or withdrawn, you shall be provided with medication or other medical treatment to alleviate pain, and you will be provided with oral consumption of food and water if you are able to eat or drink.

Q: What is the health care proxy portion of an Advance Directive?

A: A health care proxy is a person who is authorized to make medical treatment decisions for you in the event that you are unable to make such decisions. Section II of Oklahoma’s Advance Directive allows you to appoint a health care proxy (such as your spouse or adult child) to make whatever medical treatment decisions you could make if you were able. You can also appoint an alternate (back-up) health care proxy to serve in the event your health care proxy is unable or unwilling to serve. Your physician is directed to follow the instructions of your health care proxy. While your health care proxy can make decisions regarding life-sustaining treatment and artificially administered food and water, such decisions must be in accord with your wishes on those subjects as you specify in the living will portion of your Advance Directive. Therefore it is important that you discuss these subjects in advance with your health care proxy and that you choose someone who supports your wishes as set forth in your living will.

Q: May I direct organ donation in my Advance Directive?

A: Yes; Section III, titled “Anatomical Gifts,” gives you the opportunity to direct the donation of your entire body or designated body organs.

Q: What happens if my attending physician does not want to comply with my wishes as expressed in my Advance Directive?

A: In that case, your attending physician is required, as promptly as practicable, to take all reasonable steps to arrange for your care by another physician.

Q: Is the Advance Directive honored by my attending physician if I am pregnant?

A: Oklahoma law provides that a person who has been diagnosed as pregnant and whose attending physician is aware of the diagnosis will be provided with life-sustaining treatment and artificially administered hydration and nutrition unless the person has, in her own words, specifically authorized that during a course of pregnancy, life-sustaining treatment and/or artificially administered hydration and/or nutrition shall be with­held or withdrawn.

Q: Can I be required to complete an Advance Directive?

A: No. It is illegal for anyone to require that you execute an Advance Directive as a condition of receiving health care services or health insurance coverage. It is also illegal for anyone to modify your life insurance coverage, or to refuse to issue life insurance coverage to you, because you have executed an Advance Directive.

Q: Are Directives to a Physician or Advance Directives executed under prior laws still valid?

A: Yes. If you signed a Directive to Physicians under the Oklahoma Natural Death Act, which was the law in effect prior to Sept. 1, 1992, or an Advance Directive for Health Care under the law in effect prior to May 2006, it remains valid until you revoke it. However, it is recommended that you consider signing a new Advance Directive for Health Care because of additional options available to you under the current law.

Q: Does the Advance Directive require my signature more than one time?

A: The Advance Directive requires that you initial multiple times but requires your signature only once at the end. Remember that this is a legal document, and if questions arise concerning portions that seem unclear, you may wish to discuss them with your physician and/or attorney.

Q: How is the Advance Directive different from a Do-Not-Resuscitate (DNR) Consent?

A: A DNR consent form deals only with the subject of cardiopulmonary resuscitation (CPR) in the event of a cardiac or respiratory arrest. In such a document, a person can state that the person does not consent to the administration of CPR in the event the person’s heart stops beating or the person stops breathing.

Q: If I sign an Advance Directive how am I protected from a misjudgment by a physician?

A: Oklahoma law requires that both your attending physician and another physician who has examined you determine that you are incapable of making an informed decision regarding your health care, including the provision, withholding or withdrawal of life-sustaining treat­ment. This determination has to become part of your medical record.

Q: Can I revoke a signed Advance Directive?

A: Yes. An Advance Directive may be revoked by you, either entirely or as to any part, at any time and in any manner, regardless of your mental or physical condition. The revocation becomes effective when you (or a person who witnessed the revocation) notify your attending physician or other health care provider of the revocation.

Q: If I have signed more than one Advance Directive, which one will be effective?

A: In the event you signed more than one valid Advance Directive, none of which have been revoked by you, the most recently signed Advance Directive will be considered your last wishes and the one given effect.

Q: Is a document executed in another state and simi­lar to Oklahoma’s Advance Directive for Health Care honored in Oklahoma?

A: If you signed an Advance Directive in another state, which provides for the withholding or withdrawal of life-sustaining treatment or for the appointment of another to provide, withhold or withdraw life-sustaining treatment, and that document complied with the law of the state in which signed, it is valid in Oklahoma to the extent it does not exceed authorizations under Oklahoma law. However, Oklahoma residents should sign an Advance Directive that complies with the Oklahoma law if at all possible.

Q: After signing an Advance Directive, to whom should I give copies?

A: You should consider making copies of your Advance Directive for your personal records, your family, your phy­sician, your attorney, your health care proxy and alternate health care proxy. Have additional copies ready to take with you when you require hospitalization or other care as your health care providers will need a copy for your medical record. You should keep a list of persons to whom you have given a copy of your Advance Directive so that if you later change it or revoke it, you may collect the copies.

Q: Where can I acquire a copy of an Advance Directive?

A: A copy of an Advance Directive for Health Care may be downloaded here from the Oklahoma Bar Association, or obtained from your attorney.

(Revised October 2012)
All Rights Reserved
Copyright ©2012 Oklahoma Bar Association

Sample Advance Directive Form – American Family Physician

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education website.

This form is a combined durable power of attorney for health care and a living will (in some jurisdictions). With this form, you can name someone to make medical decisions for you if in the future you’re unable to make those decisions yourself. You can also say what medical treatments you want and what medical treatments you don’t want if in the future you’re unable to make your wishes known.

Instructions

Read each section carefully. Before you fill out the form talk to the person you want to name, to make sure that he/she understands your wishes and is willing to take the responsibility. Write your initials in the blank spaces before the choices you want to make. Write your initials only beside the choices you want under Parts 1, 2 and 3 of this form. Your advance directive should be valid for whatever part(s) you fill in, as long as it is properly signed.

Add any special instructions in the blank spaces provided. You can write additional comments on a separate sheet of paper, but you should write on this form that there are additional pages to your advance directive. Sign the form and have it witnessed. Give copies to your doctor, your nurse, the person you name to make your medical decisions for you, people in your family and anyone else who might be involved in your care. Discuss your advance directive with them.

Understand that you may change or cancel this document at any time.

Definitions to Know

Advance directive—A written document (form) that tells what a person wants or doesn’t want if he/she in the future can’t make his/her wishes known about medical treatment.

Artificial nutrition and hydration—When food and water are fed to a person through a tube.

Autopsy—An examination done on a dead body to find the cause of death.

Comfort care—Care that helps to keep a person comfortable but doesn’t make him/her get well. Bathing, turning and keeping a person’s lips moist are types of comfort care.

CPR (cardiopulmonary resuscitation)—Treatment to try to restart a person’s breathing or heartbeat. CPR may be done by pushing on the chest, by putting a tube down the throat or by other treatment.

Durable power of attorney for health care—An advance directive that names someone to make medical decisions for a person if in the future he/she can’t make his/her own medical decisions.

Life-sustaining treatment—Any medical treatment that is used to keep a person from dying. A breathing machine, CPR, and artificial nutrition and hydration are examples of life-sustaining treatments.

Living will—An advance directive that tells what medical treatment a person does or doesn’t want if he/she is not able to make his/her wishes known.

Organ and tissue donation—When a person permits his/her organs (such as the eyes or kidneys) and other parts of the body (such as the skin) to be removed after death to be transplanted for use by another person or to be used for experimental purposes.

Persistent vegetative state—When a person is unconscious with no hope of regaining consciousness even with medical treatment. The body may move and the eyes may be open, but as far as anyone can tell, the person can’t think or respond.

Terminal condition—An ongoing condition caused by injury or illness that has no cure and from which doctors expect the person to die even with medical treatment. Life-sustaining treatments will only prolong the dying process if the person is suffering from a terminal condition.

Complete this portion of advance directive form

I, _____________________________________________________________, write this document as a directive regarding my medical care.

In the following sections, put the initials of your name in the blank spaces by the choices you want.

PART 1. My Durable Power of Attorney for Health Care

______ I appoint this person to make decisions about my medical care if there ever comes a time when I cannot make those decisions myself. I want the person I have appointed, my doctors, my family and others to be guided by the decisions I have made in the parts of the form that follow.

Name: ______________________________________________________________________________

Home telephone: ____________________________ Work telephone: _______________________

Address: ____________________________________________________________________________

____________________________________________________________________________

If the person above cannot or will not make decisions for me, I appoint this person:

Name: ______________________________________________________________________________

Home telephone: ___________________________ Work telephone: ________________________

Address: ____________________________________________________________________________

____________________________________________________________________________

______ I have not appointed anyone to make health care decisions for me in this or any other document.

PART 2. My Living Will

These are my wishes for my future medical care if there ever comes a time when I can’t make these decisions for myself.

A. These are my wishes if I have a terminal condition

Life-sustaining treatments

_____ I do not want life-sustaining treatment (including CPR) started. If life-sustaining treatments are started, I want them stopped.

_____ I want the life-sustaining treatments that my doctors think are best for me.

_____ Other wishes _________________________________________________________________________

Artificial nutrition and hydration

_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.

_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.

_____ Other wishes _________________________________________________________________________

Comfort care

_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.

_____ Other wishes _________________________________________________________________________

B. These are my wishes if I am ever in a persistent vegetative state

Life-sustaining treatments

_____ I do not want life-sustaining treatments (including CPR) started. If life-sustaining treatments are started, I want them stopped.

_____ I want the life-sustaining treatments that my doctors think are best for me.

_____ Other wishes _________________________________________________________________________

Artificial nutrition and hydration

_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.

_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.

_____ Other wishes _________________________________________________________________________

Comfort care

_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.

_____ Other wishes _________________________________________________________________________

C. Other directions

You have the right to be involved in all decisions about your medical care, even those not dealing with terminal conditions or persistent vegetative states. If you have wishes not covered in other parts of this document, please indicate them below.

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

PART 3.

Other Wishes

A. Organ donation

_____ I do not wish to donate any of my organs or tissues.

_____ I want to donate all of my organs and tissues.

_____ I only want to donate these organs and tissues: ___________________________________________

_____ Other wishes _________________________________________________________________________

B. Autopsy

_____ I do not want an autopsy.

_____ I agree to an autopsy if my doctors wish it.

_____ Other wishes _________________________________________________________________________

C. Other statements about your medical care

If you wish to say more about any of the choices you have made or if you have any other statements to make about your medical care, you may do so on a separate piece of paper. If you do so, put here the number of pages you are adding: _____________

PART 4. Signatures

You and two witnesses must sign this document before it will be legal.

A. Your signature

By my signature below, I show that I understand the purpose and the effect of this document.

Signature ________________________________________________________ Date ____________________

Address ___________________________________________________________________________________

B. Your witnesses’ signatures

I believe the person who has signed this advance directive to be of sound mind, that he/she signed or acknowledged this advance directive in my presence and that he/she appears not to be acting under pressure, duress, fraud or undue influence. I am not related to the person making this advance directive by blood, marriage or adoption nor, to the best of my knowledge, am I named in his/her will. I am not the person appointed in this advance directive. I am not a health care provider or an employee of a health care provider who is now, or has been in the past, responsible for the care of the person making this advance directive.

Witness #1

Signature ________________________________________________________ Date ____________________

Address ___________________________________________________________________________________

Witness #2

Signature ________________________________________________________ Date ____________________

Address ___________________________________________________________________________________

Advance Directives | American Medical Association

Code of Medical Ethics Opinion 5.2

Code of Medical Ethics Opinion 5.2

Respect for autonomy and fidelity to the patient are widely acknowledged as core values in the professional ethics of medicine. For patients who lack decision-making capacity, these values are fulfilled through third-party decision making and the use of advance directives. Advance directives also support continuity of care for patients when they transition across care settings, physicians, or health care teams.

Advance directives, whether oral or written, advisory or a formal statutory document, are tools that give patients of all ages and health status the opportunity to express their values, goals for care, and treatment preferences to guide future decisions about health care. Advance directives also allow patients to identify whom they want to make decisions on their behalf when they cannot do so themselves. They enable physicians and surrogates to make good-faith efforts to respect the patient’s goals and implement the patient’s preferences when the patient does not have decision-making capacity.

An advance directive never takes precedence over the contemporaneous wishes of a patient who has decision-making capacity.

In emergency situations when a patient is not able to participate in treatment decisions and there is no surrogate or advance directive available to guide decisions, physicians should provide medically appropriate interventions when urgently needed to meet the patient’s immediate clinical needs. Interventions may be withdrawn at a later time in keeping with the patient’s preferences when they become known and in accordance with ethics guidance for withdrawing treatment.

Before initiating or continuing treatment, including, but not limited to, life-sustaining interventions, the physician should:

1. Assess the patient’s decision-making capacity in the current clinical circumstances.
2. Ascertain whether the patient has an advance directive and if so, whether it accurately reflects his/her current values and preferences. Determine whether the patient’s current clinical circumstances meet relevant thresholds set out in the directive.
3. Ascertain whether the patient has named a health care proxy (e.g., orally or through a formal legal document). If the patient has not, ask who the patient would want to have make decisions should he or she become unable to do so.
4. Document the conversation, including the patient’s goals for care, and specific preferences regarding interventions and surrogate decision maker, in the medical record; incorporate any written directives (as available) into the medical record to ensure they are accessible to the health care team.
5. When treatment decisions must be made by the patient’s surrogate, help the surrogate understand how to carry out the patient’s wishes in keeping with the advance directive (when available), including whether the directive applies in the patient’s current clinical circumstances and what medically appropriate interventions are available to achieve the patient’s goals for care. When conflicts arise between the advance directive and the wishes of the patient’s surrogate, the attending physician should seek assistance from an ethics committee or other appropriate institutional resource.
6. When a patient who lacks decision-making capacity has no advance directive and there is no surrogate available and willing to make treatment decisions on the patient’s behalf, or no surrogate can be identified, the attending physician should seek assistance from an ethics committee or other appropriate resource in ascertaining the patient’s best interest.
7. Document physician orders to implement treatment decisions in the medical record, including both orders for specific, ongoing interventions (e. g., palliative interventions) and orders to forgo specific interventions (e.g., orders not to attempt resuscitation, not to intubate, not to provide antibiotics or dialysis).

AMA Principles of Medical Ethics: I, IV

Read more opinions about this topic

Read more opinions about this topic

Code of Medical Ethics: Caring for Patients at the End of Life

Visit the Ethics main page to access additional Opinions, the Principles of Medical Ethics and more information about the Code of Medical Ethics.

90,000 An Advance Directive is … What is an Advance Directive?

Advance Directive

service-combat document on command and control of troops and bodies, is developed with the aim of timely orientation of subordinate commanders (chiefs) and staffs about upcoming actions, as well as providing more time to prepare for them. Etc. It is usually given by the chief of staff on behalf of the commander (chief) after the commander (chief) has developed an action plan.It indicates an indicative task for the implementation of which you must be prepared.

Frontier Dictionary. – M .: Academy of the Federal PS of the Russian Federation.
2002.

• Lawful Conduct
• Preliminary Investigation

See what “Advance Directive” is in other dictionaries:

• PRELIMINARY ORDER – In health insurance: a signed document containing the wishes of the applicant regarding the nature of the medical intervention that can be carried out with his consent in the event that he subsequently loses the ability … … Insurance and risk management.Terminological Dictionary

• PRELIMINARY INVESTIGATION – the activities of the bodies of inquiry and preliminary investigation regulated by the criminal procedure law, aimed at prompt and complete disclosure of crimes, exposing the perpetrators and ensuring the correct application of the law so that . .. Encyclopedia of Lawyer

• bastapқy өkim – (Advance order) әskerlerge zhauyngerlik mindetter қoyur aldynda beriletin өkimderdin bir tүri.B.ө., әdette, қol astynday commander men shtardy aldaғy kimyldar turaly uaқytynda baғdarlandyru, sondai aқzheke uramdy, әskeri … … Kazakh explanatory terminological dictionary on military affairs

• 214th Airborne Brigade (1st Formation) – 214th Airborne Brigade Troops: Air Force Type of Troops: Airborne 214 I Airborne … Wikipedia

• Regulation of state estates in the Baltic provinces – These estates in the past either came into the possession of private individuals by the most merciful grant, or were leased from public auctions, or were in administration: in the latter case, it was appointed … … …A. Brockhaus and I.A. Efron

• Regulation of state estates – in the Baltic provinces. In the past, these estates either came into the possession of private individuals by the most merciful grant, or were leased out from public auctions, or were in the administration: in the latter . .. … Brockhaus and I.A. Efron

• 204th Airborne Brigade – Honorary titles: Name of the Troops: Air Force … Wikipedia

• 307th Infantry Regiment – in the 61st Infantry Division (1st formation) and 61st Infantry Division (2nd formation).Contents 1 As part of the 61st Infantry Division of the 1st formation … Wikipedia

• 74th Infantry Division (Yeoman) – (74th (Yeomanry) Division) … Wikipedia

• Physical person – (Physical person) The concept of an individual, legal capacity of individuals The concept of an individual, legal capacity of individuals, legal relations of individuals Contents Contents Individuals as participants in civil legal relations. … … Investor encyclopedia

ADVANCE DIRECTIVE | INSURANCE TODAY

Advance Directives / Living Will

Medical prescriptions

You have the right to give written instructions to health care providers about what kind of health care you want or don’t want. This is important if you are so sick or injured that you cannot speak for yourself. These guidelines are referred to as Ordinance . Advance directives are legal documents that you prepare while you are healthy. In Colorado these are:

• Long-term medical power of attorney. This is the name of someone you trust to make medical decisions for you if you cannot speak for yourself.
• Live will. This will tell your doctor what life support procedures you want and don’t want.
• Cardiopulmonary Resuscitation (CPR) Directive. This is also known as a Do Not Reanimate order. He instructs healthcare providers not to revive you if your heart and / or lungs stop working.

Ask your PCP for facts about advance directives. Your PCP will have an advance directive form that you can fill out.

Your PCP will ask you if you have an advance directive and if you want a copy on your medical record. However, prior directives are not required to receive health care.

If you would like more information on advance directives, you can go to the Colorado State website and read the State Advance Directives Act. This link is for informational purposes only. It is not intended to provide legal advice or advice on what to do.

If you believe your suppliers are not complying with your advance directive, you can file a complaint with the Colorado Department of Health and Environment.You can find a contact number by following this link to your local Department of Public Health.

Behavioral Health Order in relation to the scope of treatment

In August 2019, Colorado passed a law allowing you to have a Behavioral Health Order to determine the scope of your treatment. It is also called the Psychiatric Advanced Directive (PAD). Like the medical advanced directive, the PAD is a legal document that outlines your choices regarding future mental health treatment. PAD is used to make sure your wishes are known if you are unable to make a decision on your own due to a mental health crisis.

You can find out more about the preliminary directives by following our links below.

You can attend our Advance Directive Workshop – Life Care Planning on the last Thursday of every month. Click here for more information!

90,000 Preliminary agreement on the provision of a land plot / State services of Moscow

You can send a message to the executive authorities of the city of Moscow as part of a pre-trial appeal.

Control over
execution of administrative regulations for the provision of public services
the city of Moscow is carried out by the Main Control Department of the City of Moscow

ADMINISTRATIVE
REGULATION

PROVISIONS
STATE SERVICES OF THE CITY OF MOSCOW

“PRELIMINARY
APPROVAL OF PROVISION OF LAND PLOT “

Pre-trial
(out-of-court) procedure for appealing decisions and actions (inaction) of the Department
and its officers

1. The applicant
has the right to file a pre-trial (out-of-court) complaint against the decision and (or)
action (inaction) of the Department and its (her) officials when providing
public service.

2. Feed and
consideration of complaints is carried out in the manner prescribed by Chapter 2.1
Federal Law of July 27, 2010 No. 210-FZ “On the organization of the provision of
state and municipal services “, Regulations on the specifics of filing and
consideration of complaints about violation of the procedure for the provision of public services
of the city of Moscow, approved by the decree of the Moscow Government dated November 15
2011 r.No. 546-PP “On the provision of state and municipal services in
the city of Moscow “, these Regulations.

3. Applicants may
to file complaints in the following cases:

3.1. Violations
the deadline for registering the request and other documents required to provide
government services.

3.2. Requirements from
applicant:

3. 2.1. Documents,
the submission of which by the applicant for the provision of public services is not
stipulated by regulatory legal acts of the Russian Federation and the city
Moscow, including documents obtained using the interdepartmental
information interaction.

3.2.2. Appeals
for the provision of services not included in the approved by the Government of Moscow
list of services that are necessary and mandatory for
provision of public services.

3.2.3. Introductions
fees for the provision of public services not provided for by regulatory
legal acts of the Russian Federation and the city of Moscow.

3.2.4. Documents
or information, the absence and (or) unreliability of which was not indicated when
initial refusal to accept documents required to provide
public service, or in the provision of public services, for
except for the cases provided for in clause 4 of part 1 of article 7 of the Federal
of the law of July 27, 2010 No.No. 210-FZ “On the organization of the provision of
state and municipal services “.

3.3. Violations
the term for the provision of public services.

3.4. Rejection
applicant:

3.4.1. In reception
documents, the submission of which is provided for by regulatory legal acts
The Russian Federation and the city of Moscow for the provision of public services,
on grounds not provided for by the regulatory legal acts of the Russian
Federation and the city of Moscow.

3.4.2. IN
the provision of public services on grounds not provided for
regulatory legal acts of the Russian Federation and the city of Moscow.

3.4.3. IN
correction of typographical errors and errors in the issued as a result of the provision of
public service documents or in case of violation of the deadline
such fixes.

3.5. Others
violations of the procedure for the provision of public services established
regulatory legal acts of the Russian Federation and the city of Moscow.

4. Complaints about
decisions (actions, inaction) of officials, state civil
employees of the Department are considered by the head of the Department or
the authorized deputy head of the Department.

Complaints against decisions
and (or) actions (inaction) of the head of the Department, including on
decisions made by him or his authorized deputy on received in
pre-trial (out-of-court) complaints, are considered by a higher authority
executive power of the city of Moscow in accordance with paragraphs 5.6, 6 applications
6 to the decree of the Moscow Government dated November 15, 2011 No. 546-PP “On
provision of state and municipal services in the city of Moscow “.

5. Complaints may
be submitted to the bodies authorized for their consideration, in writing at
paper, in electronic form in one of the following ways:

5.1. With personal
application of the applicant (representative of the applicant).

5.2. Postal
departure.

5.3. Using
Portal if technically feasible.

5.4. FROM
using the official website of the Department in information and telecommunication
the Internet.

6. The complaint must
contain:

6.1. Name
the body authorized to consider the complaint or the position and (or) surname,
name and patronymic (if any) of the relevant official to whom
a complaint is sent.

6.2. Name
executive authority of the city of Moscow or position and (or) surname, name,
patronymic (if any) of an official, state or municipal
an employee, employee whose decisions and actions (inaction) are appealed.

6.3. Surname, name,
patronymic (if any), information about the place of residence of the applicant – physical
a person, including those registered as an individual
entrepreneur, or the name, information about the location of the applicant –
legal entity, as well as contact telephone number (s), address (addresses)
e-mail (if available) and mailing address to which should be sent
response to the applicant.

6.4. Date of filing and
registration number of the request for the provision of public services (for
except for cases of appeal against the refusal to accept the request and its registration).

6.5. Information about
decisions and actions (inaction) that are the subject of appeal.

6.6. Arguments on
on the basis of which the applicant does not agree with the contested decisions and actions (inaction).
The applicant may submit documents (if any) confirming
the applicant’s arguments, or their copies.

6.7. Applicant’s requirements.

6.8. Scroll
documents attached to the complaint (if any).

6.9. Date
drawing up a complaint.

7.The complaint must
be signed by the applicant (his representative). In case of filing a complaint with
personal appeal, the applicant (representative of the applicant) must submit
identity document.

Credentials
a representative to sign the complaint must be confirmed by a power of attorney,
executed in accordance with the legislation.

Powers of the person
acting on behalf of the organization without a power of attorney on the basis of the law, other
regulatory legal acts and constituent documents are confirmed
documents certifying his official position, as well as constituent
documents of the organization.

Status and
the powers of the legal representatives of an individual are confirmed by documents,
stipulated by federal laws.

8. Received
the complaint is subject to registration no later than the working day following the day
receipts.

9. Maximum
the term for consideration of a complaint is 15 working days from the date of its registration. Term
consideration of the complaint is 5 working days from the date of its registration in cases
appeal by the applicant:

9.1. Refusal to
acceptance of documents required for the provision of public services.

9.2. Refusal to
correction of typos and errors made in documents issued as a result of
provision of public services.

9.3. Violations
term for correcting typos and errors.

10. Based on results
consideration of the complaint, a decision is made on its satisfaction (in full or in
parts) or on refusal of satisfaction.

11. The decision must
contain:

11.1. Name
the executive authority that considered the complaint, position, surname, name,
patronymic (if any) of the official who made the decision on the complaint.

11.2. Requisites
decision (number, date, place of adoption).

11.3. Surname,
name, patronymic (if any), information about the applicant’s place of residence –
an individual or the name, information about the location of the applicant –
legal entity.

11.4. Surname,
name, patronymic (if any), information about the place of residence of the representative
the applicant who filed a complaint on behalf of the applicant.

11.5. Way
filing and date of registration of the complaint, its registration number.

11.6. Thing
complaints (information about the appealed decisions, actions, inaction).

11.7.
The circumstances and evidence established during the consideration of the complaint, their
confirming.

11.8. Legal
grounds for deciding on a complaint with reference to applicable
regulatory legal acts of the Russian Federation and the city of Moscow.

11.9. Adopted by
complaint decision (conclusion on satisfaction of the complaint or refusal to satisfy it).

11.10. Measures to
elimination of the revealed violations and the timing of their implementation (in case of satisfaction
complaints).

11.11. Information
on actions taken by the executive authority of the city of Moscow,
local government body subordinate to the executive body
and the local government by the organization providing state
service, a multifunctional center for the provision of public services in
in order to immediately eliminate the identified violations in the provision of
public service, as well as an apology for the inconvenience and information
on further actions to be taken by the applicant in order to
receiving public services (in case of satisfaction of the complaint).

11.12.
Reasoned explanations about the reasons for the decision (in case of refusal to
satisfaction of the complaint).

11.13. Order
appeal against the decision.

11.14. Signature
authorized official.

12. Solution
drawn up in writing using official forms.

13. To the number
measures specified in the decision to eliminate the identified violations, including:

13.1. Cancel earlier
decisions taken (in whole or in part).

13.2. Security
receipt and registration of the request, registration and issuance of a receipt to the applicant (if
evasion or unjustified refusal to accept documents required for
provision of public services, and their registration).

13.3. Security
registration and issuance to the applicant of the result of the provision of public services
(in case of evasion or unreasonable refusal to provide state
services).

13.4. Correction
typos and errors made in documents issued as a result
provision of public services.

13.5. Return
the applicant of funds, the collection of which is not provided for by the regulatory
legal acts of the Russian Federation and the city of Moscow.

14. Organ,
authorized to consider the complaint, refuses to satisfy it in
cases:

14.1. Confessions
the decisions and actions (inaction) appealed against are lawful and do not violate the rights and
the applicant’s freedoms.

14.2. Feed
complaints by a person whose powers are not confirmed in the manner prescribed
regulatory legal acts of the Russian Federation and the city of Moscow.

14.3. Lack of
applicant for the right to receive public services.

14.4. Stock:

14.4.1.
The court decision that has entered into legal force on the complaint of the applicant with identical
subject and grounds.

14.4.2. Solutions for
a complaint previously accepted in a pre-trial (out-of-court) procedure in relation to the same
the applicant and on the same subject of the complaint (except in cases of appeal
decisions made earlier to a higher authority).

15. Complaint
to be left unanswered on the merits in cases:

15.1. Availability in
a complaint of obscene or offensive language, threats to life, health and
property of officials, as well as their family members.

15.2. If the text
complaints (part of it), name, postal address and e-mail address are not
readable.

15.3. If in
the complaint does not indicate the name of the applicant (representative of the applicant) or postal
the address and e-mail address to which the reply should be sent.

15.4. When
admission to the body authorized to consider a complaint, a petition
the applicant (representative of the applicant) to withdraw the complaint pending a decision on
complaint.

16. Decisions about
satisfaction of the complaint and refusal to satisfy it are sent to the applicant
(to the applicant’s representative) no later than the working day following the day of their
acceptance, at the mailing address indicated in the complaint. At the request of the applicant
the decision is also sent to the e-mail address indicated in the complaint (in
the form of an electronic document signed by the electronic signature of an authorized
official). In the same manner, to the applicant (representative of the applicant)
a decision is sent on the complaint, in which only the address is indicated for the answer
e-mail, and the mailing address is missing or unreadable.

17. In case
leaving the complaint unanswered on the merits to the applicant (his representative)
sent within 5 days from the date of registration of the complaint written
a reasoned notification indicating the grounds (unless
the complaint does not indicate the postal address and e-mail address for response, or they
cannot be read). The notification is sent in the manner prescribed for
forwarding a decision on the complaint.

18. Complaint,
filed in violation of the rules of competence set out in clause 5.four
of this Regulation, is sent no later than the working day following
by the day of its registration, to the body authorized to consider the complaint, with
simultaneous written notification of the applicant (his representative) about
redirecting the complaint (except for cases when the complaint does not specify
postal address and e-mail address for reply or they do not lend themselves
reading). The notification is sent in the manner prescribed for the direction
decisions on the complaint.

19. Filing a complaint
in a pre-trial (out-of-court) procedure does not exclude the rights of the applicant (representative
applicant) for the simultaneous or subsequent filing of a complaint with a court.

20. Informing
applicants on the judicial and pre-trial (extrajudicial) procedure for appealing decisions and
actions (inaction) committed in the provision of public services,
must be done by:

20.1. Accommodation
relevant information on the Portal.

20.2.
Advising applicants, including by phone, email,
personal reception.

21. In case
establishing in the course of consideration of the complaint signs of the composition of administrative
offenses or felonies an official endowed
powers to consider the complaint, immediately sends the existing
materials to the prosecutor’s office.

22. Upon detection
violations of the procedure for the provision of public services of the city of Moscow,
responsibility for the commission of which is established by the Code of the City of Moscow on
administrative offenses, an official empowered to
consideration of the complaint, must also send copies of available materials to
Main control department of the city of Moscow within two working days,
following the day the decision on the complaint was made (but no later than a working day,
following the day of expiration of the period established by federal legislation
consideration of complaints about violations of the procedure for the provision of public services).

Provisional Directive – Financial Encyclopedia

What are the preliminary directives

An advance directive, sometimes called a living will, is a document that expresses a person’s wishes for intensive care when they cannot make a decision on their own. With advance directives, people have the right to make future decisions about their resuscitation without outside influence. A person who wants or does not want to be placed in a life support system can draw up an advance directive that hospital staff will follow in the event of a disability.

Understanding preliminary directives

An Advance Directive is a will that records a patient’s desire to undergo medical treatment at the end of life. The document states whether dialysis, breathing machines or tube feeding is required, whether to perform resuscitation, and whether organs and tissue donate at the end of life. Advance planning provides the medical care the individual desires and avoids unnecessary suffering, disagreement and the burden of decision-making in times of crisis.Two physicians must certify that the person is terminally ill, seriously injured, in a coma, in advanced dementia, or is permanently unconscious and unable to make medical decisions before the will is fulfilled in life.

An Advance Order becomes effective in the United States when signed in the presence of a witness. However, emergency medical technicians cannot fulfill the will of life; they must do everything in their power to stabilize the person for transfer to the hospital.After the doctor has fully examined the condition of the person, you can proceed with the implementation of the preliminary instructions. Completion of a new life annuls the old one. The advance directive should be updated periodically to keep abreast of the patient’s evolving desires at the end of care.

Advance order and power of attorney

The person appointed by the medical proxy must be willing to ask difficult questions and must let go of emotions about the medical procedure or option in order to ensure that the disabled person’s wishes are fulfilled at the end of life.Communicating openly with your health care proxy about potential situations is important to clarify end-of-life care preferences. Providing opinions on tube feeding and hydration, antibiotic use, mechanical ventilation, and the aggressiveness of CPR are important topics. Other issues for discussion are the person’s fears about treatment and under what circumstances they might want to take more or less aggressive measures.

A long-term power of attorney allows the designated person to act as the agent of the person and make financial decisions on his behalf in the event of incapacity.A long-term power of attorney allows you to do banking, sign social security checks, apply for disability, and write checks to cover bills. Different people can be assigned to act on behalf of a person on different issues.

# P

Administration of the Volzhsky District of Saratov – Guardianship and Guardianship

Custody and guardianship

Specialists of the sector for ensuring the execution of the transferred state powers on guardianship and guardianship carry out 90,025 reception of citizens :

Tuesday from 15.00 to 17.00 hours, Thursday from 10.00 to 12.00 hours
at the address: g . Saratov, Cathedral Square, 3, tel. 23-66-36, 23-74-26,

email – [email protected].

– Semenova Olga Valerievna – head of the sector for ensuring the execution of the transferred state powers for guardianship and trusteeship, for the protection of property and personal rights of minors; cab. No. 105,

– Uglanova Lyudmila Aleksandrovna – Leading Specialist of the Sector for Enforcement of Transferred State Powers of Guardianship and Guardianship, on the Protection of Property and Personal Rights of Minors, Adoption; cab.No. 105,

– Bazlova Angelina Grigorievna – Specialist of the 1st category of the sector for ensuring the implementation of the transferred state powers of guardianship and guardianship, on the protection of personal and property rights of minors in state institutions; cab. No. 103,

– Klimova Natalya Gennadievna – chief specialist of the sector for ensuring the execution of the transferred state powers for guardianship and guardianship, for guardianship and guardianship of minors; cab.No. 105,

– Garchuk Natalya Nikolaevna – Specialist of the 1st category of the sector for ensuring the execution of the transferred state powers for guardianship and guardianship, for guardianship and guardianship in relation to adult citizens; on the protection of property and personal rights of the incapacitated; cab. No. 103.

Reception of citizens is carried out by specialists of the sector without an appointment in the first place.

You can familiarize yourself with the normative legal acts , in accordance with which the transferred state powers on guardianship and guardianship are carried out, , at link .

Administrative regulations , on the basis of which the guardianship and guardianship authority provides state services for the protection of minors’ rights (http://minobr.saratov.gov.ru/activities/juvenile/docs/reglaments.php):

Order 2158 of 18.10.2018 with attachments

TECHNOLOGICAL SCHEME provision of public services’ consent to the exchange premises, which are granted under the contract of social hiring, and in which living ADULTS incapable or partially capable citizens who are family members of EMPLOYERS DATA RESIDENTIAL »

TECHNOLOGICAL SCHEME OF PROVISION OF PUBLIC SERVICES “ISSUE OF PRELIMINARY PERMISSION FOR DISPOSAL OF PROPERTY OF AN ADVANCED INAPPROPRIATE (NOT FULLY AVAILABLE) CITIZEN”

TECHNOLOGICAL SCHEME OF PROVISION OF PUBLIC SERVICES “ISSUE OF A PRELIMINARY PERMISSION OF THE BODY OF GUARDIANS AND GUARDIANS AFFECTING THE EXERCISE OF PROPERTY RIGHTS.

TECHNOLOGICAL SCHEME OF PROVISION OF STATE SERVICES “APPOINTMENT OF A GUARDIAN (GUARDIAN), ISSUE OF AN CONCLUSION ON THE POSSIBILITY OF BEING A GUARDIAN (GUARDIAN) OF AN ADVANCED INAPPROPRIATE SERVICE”

Administrative regulations “Issuance of opinions on disputes related to the upbringing of children” (Order No. 1235 of 17.05.2017)

Administrative regulations for the provision of public services by local governments “Issuance of permission to change the name and (or) surname of a minor” (Order No. 1235 of 05/17/2017)

Administrative Regulations “Issuance of an opinion on recognizing a minor as legally capable (emancipated)”, (Order No. 1928 dated 06.21.2016)

ADMINISTRATIVE REGULATIONS FOR THE PROVISION OF PUBLIC SERVICES “Issuance of a permit for separate residence of trustees and their minor wards” (Order of 04.08.2015 No. 2317 On approval of the administrative regulations “Issuance of a permit for separate residence of trustees and their minor wards”, technological scheme)

Administrative regulations “Issuance of preliminary permission for transactions with residential premises with the participation of minors”

Administrative regulations for the provision of public services by local governments “Conclusion of an agreement on the temporary stay of a child in an organization for orphans and children left without parental care” (Order No. 1268 of 18.05.2017)

Administrative regulations “Appointment of a one-time benefit for all forms of placement of orphans and children left without parental care in a family” (Technological scheme)

Administrative regulations “Acceptance of documents by the guardianship and guardianship authorities from persons wishing to accept orphans and children left without parental care for upbringing in a family (adoption, guardianship and foster family), issuance of an opinion on the possibility of temporary transfer of a child to a family and appointment monetary payments for the maintenance of orphans and children left without parental care, placed under guardianship (guardianship) “(TCMV, technological scheme)

– Administrative regulations for the provision of municipal services “Issuance of permission to marry a person (s) who has reached (have reached) the age of sixteen”,

– Administrative regulations for the provision of public services “Appointment as a guardian (trustee), issuance of an opinion on the possibility of being a guardian (custodian) of an adult incapacitated (not fully capable) citizen”,

– Administrative regulations for the provision of public services “Consent to the exchange of residential premises, which are provided under social employment contracts and in which adult incapacitated or disabled citizens live, who are family members of the tenants of these residential premises”,

– Administrative regulations for the provision of the service “Issuance of preliminary permission of the guardianship and guardianship authority affecting the exercise of property rights of an adult incapacitated (not fully capable) citizen”,

– Administrative regulations for the provision of public services “Issuance of a preliminary permit for the disposal of the property of an adult incapacitated citizen.”

Orders of the Ministry of Social Development of the Saratov Region on amendments to some orders of the Ministry of Social Development of the Saratov Region:

1. Order No. 843 dated July 26, 2017;

2. Order No. 833 dated July 25, 2017;

3. Order No. 415 dated March 29, 2017.

Resolution of the Government of the Russian Federation No. 1221 of November 19, 2016 “On Amending the Resolution of the Government of the Russian Federation No. 927 of November 17, 2010”.

Information about children who need to be placed in a family of citizens:

Adoption in Russia – http://www.usynovite.ru

I want a family – http://minobr.saratov.gov.ru/activities/juvenile/i-want-the-family

Dear guardians, trustees, foster parents!

Foster parents are obliged to take care of the maintenance of their wards, to provide them with care and treatment, to protect their rights and interests.

1. In this regard, we remind you of the need to prepare an annual report on the storage, use of the ward’s property and the management of the ward’s property.

In the period from December 20 to February 1, the substitute parent submits a written report for the previous year to the guardianship authority with the attachment of documents (copies of sales receipts, receipts for payment of taxes, insurance amounts and other payment documents).

2. In order to protect the property rights of minor wards, the guardian (curator), foster parent, as the legal representative of the child, is obliged to monitor the fulfillment by the parents of the obligation to pay alimony for the maintenance of the child.

In case of long-term non-payment of alimony for the maintenance of the ward child, the guardian (curator) must submit an application to the bailiff service with a request to consider the issue of bringing the parent (s) to criminal liability. A copy of this application with a note of acceptance by the bailiff service, as well as the calculation of the debt for the payment of alimony, you must provide to the guardianship and trusteeship authorities.

3. According to the order of the Ministry of Health of the Russian Federation of 11.04.2013 No. 216n “On approval of the Procedure for medical examination of orphans and children left without parental care, including those adopted (adopted), taken under guardianship (guardianship), into a foster family and a foster family”; medical examination of children placed under guardianship (guardianship) is a set of measures, including a medical examination by doctors of several specialties and the use of the necessary examination methods.

Clinical examination is carried out annually in order to timely identify pathological conditions, diseases and a risk factor for their development, as well as in order to form groups of health status and develop recommendations for minors.

After the ward undergoes medical examination, you need to submit to the guardianship and trusteeship sector of the Volzhsky District Administration of the City of Saratov Municipal Formation the appropriate medical report to be attached to the ward’s personal file.

Order of the Government of the Russian Federation dated April 24, 2020 No. 1131-r

GOVERNMENT OF THE RUSSIAN FEDERATION

ORDER

of April 24, 2020No. 1131-p

MOSCOW

In order to organize the provision of timely and high-quality medical care to patients with a confirmed diagnosis of a new coronavirus infection COVID-19 or suspected of a new coronavirus infection COVID-19 in the Russian Federation:

1. Approve the attached preliminary list of organizations and their structural units carrying out medical activities, subordinate to the federal executive authorities, and private medical organizations that are re-profiled to provide medical care to patients with a confirmed diagnosis of a new coronavirus infection COVID-19 or suspected of a new coronavirus infection COVID-19 in stationary conditions under special instructions (hereinafter referred to as the list).
2. To retain for the relevant federal executive bodies the exercise of the powers of the founders of the organizations subordinate to them, indicated in the list.
3. The supreme executive bodies of state power of the constituent entities of the Russian Federation shall ensure:

   approval by a regulatory legal act of the constituent entity of the Russian Federation agreed with the federal executive bodies exercising the powers of the founders of their subordinate organizations specified in the list and the founders of private medical organizations specified in the list (hereinafter – subordinate and private organizations), routing schemes for patients with a confirmed diagnosis of a new coronavirus infection COVID-19 or suspected of a new coronavirus infection COVID-19 for these organizations, depending on the severity of the condition of such patients;

   Inclusion of a person authorized by the Ministry of Health of Russia in the corresponding operational headquarters of a constituent entity of the Russian Federation.

4. Federal executive bodies exercising the powers of founders of subordinate organizations, and founders of private organizations, together with the highest executive bodies of state power of the constituent entities of the Russian Federation, shall organize:

re-profiling of subordinate and private organizations in accordance with the minimum requirements for the implementation of medical activities aimed at the prevention, diagnosis and treatment of the new coronavirus infection COVID-19, approved by the Ministry of Health of Russia;

, together with the heads of subordinate and private organizations, staffing them with personnel trained to work with patients with a confirmed diagnosis of a new coronavirus infection COVID-19 or suspected of a new coronavirus infection COVID-19

5. Heads of subordinate and private organizations in conjunction with the highest executive bodies of state power constituent entities of the Russian Federation and federal executive bodies exercising the powers of the founders of subordinate organizations, and the founders of private organizations to organize the necessary work to provide a centralized supply of medical gases (oxygen) with a system of centralized supply of medical gases (oxygen) to the additionally created or repurposed bed fund of subordinate and private organizations to provide medical care to patients infection with COVID-19 in accordance with the minimum requirements for the implementation of medical activities aimed at prophylaxis treatment, diagnosis and treatment of the new coronavirus infection COVID-19, approved by the Ministry of Health of Russia, as well as equipping (re-equipping) the specified bed fund in accordance with the procedures for providing medical care in the profiles of “anesthesiology and resuscitation”, “pulmonology” for infectious diseases.