Advance Care Plan Form – Fill Out and Use This PDF

An Advance Care Plan form, also known as an advance directive, is a legal document that records your healthcare preferences before a medical emergency arises. It specifies your wishes on life-sustaining treatment, resuscitation, and artificial nutrition, and designates a healthcare agent to speak for you when you cannot. This document spares your family difficult decisions during stressful times and ensures your care team follows your exact values. Click the button below to fill out your Advance Care Plan form online today.

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Advance Care Plan Form PDF Details

An Advance Care Plan form works alongside related legal documents to give healthcare providers complete guidance on your medical wishes. It is typically used together with a health care proxy form, which designates your chosen decision-maker, and a POLST form, which translates your preferences into active medical orders. For residents of states with specific healthcare directive laws, a state-specific advance healthcare directive may also be required for the document to be legally valid.

The Advance Care Plan addresses your preferences on resuscitation, mechanical ventilation, artificial nutrition, comfort care, and palliative care priorities. It also provides space for organ donation preferences. Once signed and witnessed according to your state's requirements, distribute copies to your primary care physician, your designated healthcare agent, and family members involved in your care. Keeping a copy in a clearly visible location at home ensures medical teams can access it quickly during an emergency.

Question	Answer
Form Name	Advance Care Plan Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	advance directive, advance healthcare directive, durable power of attorney for healthcare, healthcare directive

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How to Edit Advance Care Plan Form Online for Free

Completing an Advance Care Plan form requires careful thought about your medical values and the people you trust to make decisions on your behalf. Follow these steps to fill out the document accurately and ensure it holds legal weight in your state.

Step 1: Identify Your Healthcare Agent

Choose a trusted person to act as your healthcare agent or proxy. This person will communicate your wishes to medical staff if you cannot speak for yourself. Name a backup agent in case your primary choice is unavailable. You can also designate your agent using a dedicated health care proxy form if your state requires a separate document.

Step 2: State Your Treatment Preferences

Specify which life-sustaining treatments you would or would not want. This includes cardiopulmonary resuscitation (CPR), mechanical ventilation, and artificial nutrition. Be as specific as possible so medical staff understand your intentions without ambiguity. For patients with serious illnesses, a POLST form may supplement your advance care plan with immediate medical orders your care team can follow.

Step 3: Document Comfort Care and Organ Donation Wishes

Indicate your priorities regarding pain management and quality-of-life care. State whether you prefer treatments that focus on comfort rather than prolonging life. Include your preferences on organ and tissue donation if you wish to address this within the same document.

Step 4: Meet Signature and Witness Requirements

Most states require your Advance Care Plan to be signed by two adult witnesses who are not your healthcare agent, not your relatives, and not your healthcare providers. Some states additionally require notarization. Review your state's laws before signing to confirm the document will be legally recognized.

Step 5: Distribute and Store Your Completed Form

Give signed copies to your healthcare agent, your primary care physician, any hospital where you receive regular care, and family members who should know your wishes. Keep the original in an accessible location at home and consider registering with your state's advance directive registry if one exists.