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Patient Name:___ 1.AUTHORIZATION FOR TREATMENT FINANCIAL RESPONSIBILITY FINANCIAL INTEREST DISCLOSURECONSENTI authorize my physician and other physicians that may treat me, their associates and assistants

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How to fill out making a personal directive

01

Decide what your personal care and medical treatment preferences are.

02

Choose a trusted individual to be your substitute decision maker.

03

Write down your wishes in a personal directive document.

04

Sign and date the personal directive in the presence of witnesses.

05

Give copies of your personal directive to your substitute decision maker, healthcare providers, and anyone else who may need to know.

Who needs making a personal directive?

01

Anyone who wants to ensure that their personal care and medical treatment preferences are followed when they are unable to communicate.

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What is making a personal directive?

Making a personal directive involves creating a legal document that outlines your preferences for medical treatment and personal care in case you are unable to communicate your wishes.

Who is required to file making a personal directive?

Anyone who wants to ensure their healthcare and personal care preferences are followed in case they become incapacitated and unable to communicate their wishes.

How to fill out making a personal directive?

You can fill out a personal directive by clearly stating your preferences for medical treatment, personal care, and appointing a trusted individual to make decisions on your behalf if needed.

What is the purpose of making a personal directive?

The purpose of making a personal directive is to ensure that your wishes regarding medical treatment and personal care are followed when you are unable to communicate them.

What information must be reported on making a personal directive?

A personal directive should include information about your preferences for medical treatment, personal care, and the appointment of a decision-maker.

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