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Capacity Trackers Guide Hospice Providers Version 4.0 14 August 20201Table of Contents Document Revision History...........................................................................................................................................

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How to fill out form 4 advance care

01

Obtain a copy of form 4 advance care from a healthcare provider or the internet.

02

Fill in your personal details including name, address, and contact information.

03

Specify your preferences for medical treatment and care in the event that you are unable to communicate your wishes.

04

Sign and date the form in the presence of witnesses who are not your healthcare providers or family members.

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Who needs form 4 advance care?

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Anyone who wants to ensure their wishes for medical treatment and care are followed in the event that they are unable to communicate them.

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What is form 4 advance care?

Form 4 advance care is a legal document that allows an individual to specify their wishes for medical treatment in case they become incapacitated.

Who is required to file form 4 advance care?

Any individual who wants to ensure their medical preferences are known and followed if they cannot communicate them themselves.

How to fill out form 4 advance care?

Form 4 advance care can be filled out by providing personal information, choosing a healthcare agent, specifying medical treatment preferences, and signing the document in front of witnesses.

What is the purpose of form 4 advance care?

The purpose of form 4 advance care is to give individuals control over their medical treatment decisions in case they are unable to communicate their wishes.

What information must be reported on form 4 advance care?

Form 4 advance care typically includes information about the individual's healthcare agent, medical treatment preferences, and any specific instructions for end-of-life care.

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