The following consent forms need to be processed in person at the Patient Access Services office because certain signatures are required. This information is made available online so that you may review the forms ahead of time before your next visit to the hospital. If you wish, you may print out a copy to bring with you. (See printing instructions below.) Click on the links below to view the forms.
Understanding Advance Directives
Making an informed decision about the type(s) of Advance Directive(s) that is/are appropriate for your circumstances is the caring thing to do and it takes the burden of difficult decision making from those whom you love. There are three types of Advance Directives -- each has a specific purpose.
(Please note that these are not required to complete your pre-registration.)
- The Directive to Physicians and Family or Surrogates* provides the individual the opportunity to communicate their wishes about medical treatment at some time in the future when they are unable to make their wishes known because of illness or injury.
- The Medical Power of Attorney* gives the person you name as your agent the authority to make any and all health care decisions for you in accordance with your wishes, including your religious and moral beliefs, when you are no longer capable of making them yourself.
- The Out-of-Hospital Do Not Resuscitate Order* provides you with the right to withhold or withdraw cardiopulmonary resuscitation (CPR) or other treatments such as transcutaneous cardiac pacing, defibrillation, advanced airway management and artificial ventilation.
*This document is in a PDF format. If you are unable to view it with your browser, then you may need to download and install the free Adobe Reader.
Print: If you have a printer and would like to print out a copy of any of these forms, select a form above to view it in your browser. Then click on the File menu button at the top of your browser and select Print. You may bring the form with you to complete in the office. For best results, make sure your browser text size is set to Medium (or Times New Roman, size 12 font).