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FIVE WISHES LEM P1 2 3 4 5 SA print your namebirthdateTraditional Chinese M P LE
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How to fill out five wishes

01
To fill out Five Wishes, follow these steps:
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Start by writing down your full name and the date at the top of the form.
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For each section, read the instructions carefully and think about your preferences and wishes.
04
In the first section, you can choose a healthcare agent who will make decisions for you if you are unable to do so.
05
In the second section, specify the types of medical treatment and care you would like to receive or avoid.
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The third section allows you to talk about how comfortable you want to be, both physically and mentally.
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In the fourth section, you can express your wishes regarding how you want people to treat you.
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The final section lets you specify your preferences for your funeral and other wishes after death.
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After completing the form, sign it in the presence of two adult witnesses who also sign and date the form.
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Make copies of your completed Five Wishes form, and distribute them to your healthcare agent, family members, and healthcare providers.
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Review and update your Five Wishes as needed.

Who needs five wishes?

01
Five Wishes is a document that can be used by individuals of all ages, especially those who want to have a say in their medical treatment and care.
02
It is particularly valuable for older adults, individuals with chronic illnesses, and anyone who wants to ensure that their wishes are honored if they become unable to communicate or make decisions.
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Five Wishes is also commonly used by healthcare professionals, hospice organizations, and legal professionals to facilitate discussions about end-of-life care and advance care planning with their patients or clients.
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Five Wishes is an advance care planning document that allows individuals to express their wishes for medical care and support in the event they become unable to communicate their preferences.
Anyone who wants to ensure their medical care preferences are respected in case of incapacitation may complete and file Five Wishes, although specific requirements can vary by state.
To fill out Five Wishes, individuals need to complete the document by answering a series of questions regarding their healthcare preferences, values, and appointing someone to make decisions on their behalf.
The purpose of Five Wishes is to guide healthcare providers and loved ones in making medical decisions that align with an individual's values and desires when they are unable to do so.
The information reported on Five Wishes includes the individual's health care preferences, the designation of a health care proxy, and specifics on end-of-life care choices and emotional, spiritual, and personal considerations.
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