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Medical Directive &/or Delegation Template for Use by Physicians or Authorizers with Ordering Authority Title: Number:

How to fill out medical directive or delegation

How to fill out a medical directive or delegation:

1. Start by gathering the necessary documents. You will typically need a medical directive form, which outlines your specific medical wishes, and a delegation of authority form, which designates someone to make medical decisions on your behalf.
2. Begin by filling out your personal information on both forms. This may include your full name, date of birth, address, and contact information.
3. In the medical directive form, clearly outline your healthcare preferences. This can include instructions on life-sustaining treatments, organ donation, pain management, and other medical decisions. It is important to be specific and provide clear instructions to ensure your wishes are followed.
4. Next, designate a healthcare proxy or agent in the delegation of authority form. This person will be responsible for making medical decisions on your behalf if you are unable to do so. Be sure to choose someone you trust and discuss your medical preferences with them beforehand.
5. Complete any additional sections or requirements on the forms. This may include witness signatures, notarization, or specific state requirements. Be sure to review the forms thoroughly and follow all instructions provided.
6. Once the forms are filled out, make copies for yourself, your healthcare proxy, and any healthcare providers involved in your care. It is also recommended to provide copies to your regular doctor or hospital to keep on file.
7. Finally, review and update your medical directive and delegation of authority forms regularly. Your preferences or chosen healthcare proxy may change over time, so it is important to keep these documents up to date.

Who needs a medical directive or delegation:

1. Individuals who want to have a say in their medical treatment decisions, even if they are unable to communicate or make decisions themselves.
2. People who have specific medical wishes or preferences that they want to ensure are followed in the event of an emergency or incapacitation.
3. Individuals who want to designate someone they trust to make healthcare decisions on their behalf.

It is important to consult with a legal professional or healthcare provider to ensure you understand the legal requirements and implications of filling out a medical directive or delegation. They can provide guidance and assistance in completing these forms accurately and according to your specific needs.

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