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EXTENDED CARE REQUISITION2119 E. 93rd / L15 Cleveland, OH 44106 216.444.5755 or 800.628.6816FORM_CLIENT INFORMATIONPATIENT INFORMATION (PLEASE PRINT IN BLACK INK) ___ Last NameFirstMI ___ AddressBirth
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How to fill out advance care planning and

01
Start by thinking about your values, beliefs, and goals for medical care.
02
Choose a healthcare proxy or decision maker who understands your wishes.
03
Fill out advance care planning forms, such as a living will or healthcare power of attorney.
04
Discuss your wishes with your healthcare proxy, family, and healthcare providers.
05
Review and update your advance care planning documents regularly.

Who needs advance care planning and?

01
Anyone over the age of 18 can benefit from advance care planning.
02
Those with chronic illnesses or terminal conditions may have a greater need for advance care planning.
03
Individuals who want to ensure their wishes are followed in case of medical emergencies should consider advance care planning.
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Advance care planning is a process that helps individuals outline their wishes for medical care in case they are unable to communicate their preferences.
Advance care planning is not a document that needs to be filed, but rather a process individuals can engage in to ensure their preferences for medical care are known.
There is no specific form for advance care planning, but individuals can use tools such as advance directives, living wills, and healthcare proxies to document their wishes.
The purpose of advance care planning is to ensure that an individual's preferences for medical treatment are respected and followed, even if they are unable to make decisions themselves.
Advance care planning does not require reporting of information, but rather documenting an individual's wishes for medical care.
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