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Advance Care Planning Checklist Use this checklist as a guide in your advance care planning process. Make decisions Ask yourself some questions. Imagine that you became suddenly ill or injured and
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How to fill out advance care planning checklist

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How to fill out advance care planning checklist

01
Step 1: Gather the necessary documents and information, such as your medical history, current medications, and any legal documents related to healthcare decisions.
02
Step 2: Review the advance care planning checklist to familiarize yourself with the different sections and prompts.
03
Step 3: Begin by filling out your personal information, including your name, date of birth, and contact information.
04
Step 4: Proceed to the section on healthcare proxy or power of attorney. Choose someone you trust to make healthcare decisions on your behalf if you are unable to do so.
05
Step 5: Consider your values, beliefs, and goals for healthcare and life-sustaining treatments. Use the checklist to indicate your preferences for various medical interventions or treatments.
06
Step 6: Discuss your choices with your healthcare provider, family members, or close friends. Ensure they understand your wishes and have a copy of your completed advance care planning checklist.
07
Step 7: Review and revise your advance care planning checklist periodically to reflect any changes in your medical condition or personal preferences.
08
Step 8: Keep a copy of the completed checklist in a safe and easily accessible place, and provide a copy to your healthcare provider, designated healthcare proxy, and loved ones.

Who needs advance care planning checklist?

01
Advance care planning checklists are beneficial for individuals of all ages and health conditions.
02
Anyone who wants to ensure their healthcare preferences are known and respected, particularly if they become unable to communicate or make decisions for themselves, can benefit from using an advance care planning checklist.
03
This includes individuals with chronic illnesses or terminal conditions, older adults, individuals undergoing major surgeries or medical treatments, and individuals with specific healthcare wishes or concerns.
04
It is also helpful for caregivers of individuals with complex medical needs to have access to an advance care planning checklist to guide their decision-making process.
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The advance care planning checklist is a tool that helps individuals document their preferences for medical treatment and care in case they become unable to communicate their wishes in the future.
Any individual who is of legal age and has the capacity to make decisions about their medical treatment is encouraged to fill out an advance care planning checklist.
To fill out an advance care planning checklist, individuals can start by thinking about their values, beliefs, and preferences for medical treatment, and then documenting these in the checklist form.
The purpose of advance care planning checklist is to ensure that an individual's preferences for medical treatment and care are known and respected in case they become unable to communicate their wishes in the future.
The advance care planning checklist typically includes information about the individual's preferred medical treatments, healthcare providers, and who should make healthcare decisions on their behalf if they are unable to do so.
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