Personal Directive Form PDF Details

Taking control of personal matters during times when making decisions becomes impossible due to health or other reasons is a significant concern for many. The Personal Directive form serves as a powerful legal instrument, allowing individuals to appoint agents to handle their personal affairs in such scenarios. This document becomes effective under the circumstances outlined in the Personal Directives Act, which emphasizes the need for a formal declaration of incapacity. Through the form, an individual can revoke any previous directives, designate an agent or the Public Guardian to act on their behalf, and outline the specific areas of authority granted to the agent. These areas include, but are not limited to, health care, accommodation, social activities, and legal matters. Furthermore, the form allows for the designation of an agent for the temporary care of minor children, providing specific instructions for personal matters, and sharing additional information to guide the agent's decisions. It even enables individuals to specify who can determine their capacity and how notifications should be handled if incapacity is established. Signed by the maker and in the presence of a witness, the Personal Directive is a testament to one's preferences and wishes, ensuring they are respected and upheld during times when self-advocacy is not possible.

QuestionAnswer
Form NamePersonal Directive Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namespersonal directive directives template, personal directive alberta canada, directive personal, personal directive alberta

Form Preview Example

Personal Directive

Protected A (when completed)

I,

, make this Personal Directive.

name of maker

This Personal Directive takes effect with respect to personal matters that relate to me when it is determined, in accordance with the PERSONAL DIRECTIVES ACT, that I do not have capacity to make personal decisions with respect to those matters.

I have placed my initials next to the provisions in this document that form part of my Personal Directive.

1. Revocation of previous personal directive

Not Applicable

Initials I revoke all previous personal directives made by me.

2. Designation of agent

Option One

 

Initials

I designate the following as my agent(s)

OR

Option Two

Initials

 

I designate the Public Guardian as my agent.

 

 

 

I have consulted with the Public Guardian and the Public Guardian is satisfied that no other person is able and willing to act as my agent. The Public Guardian has agreed to be my agent.

OR

Option Three

Initials

I do not wish to designate an agent, but provide the following information and instructions to be followed by a service

provider who intends to provide personal services to me.

3. Areas of authority

Option One

 

 

Initials

I give my agent(s) the authority to make personal decisions on my behalf

for all the personal matters, of a

 

 

 

 

non-financial nature, that relate to me.

 

OR

 

 

OPG5521 Rev. 2020-05

Page 1 of 4

Option Two

 

Initials

I give the following agent(s) the authority to make personal decisions on my behalf for all the following personal

matters, of a non-financial nature, that relate to me. Initials

Health Care

name(s) of agent(s)

Initials

Accommodation

name(s) of agent(s)

Initials

With whom I may live and associate

name(s) of agent(s)

Initials

Participation in social activities

name(s) of agent(s)

Initials

Participation in educational activities

name(s) of agent(s)

Initials

Participation in employment activities

name(s) of agent(s)

Initials

Legal matters

name(s) of agent(s)

Initials

Other personal matters

name(s) of agent(s)

Describe other personal matters (if applicable):

4. Designation of agent for temporary care and education of minor child(ren) (optional)

Not applicable

 

 

 

Initials

I designate

 

as an agent who has the authority to take over the care

 

 

 

 

 

 

 

 

 

and education of my minor child(ren) until one of the events described in section 7(1)(e) of the PERSONAL DIRECTIVES ACT happens.

5. Specific instructions (optional)

Not applicable

OPG5521 Rev. 2020-05

Page 2 of 4

Initials

 

I instruct my agent(s) to carry out the following specific instructions when making decisions about my personal matters:

 

 

 

Not applicable

Initials

If I have not designated an agent, or if my agent(s) are unable or unwilling to make a personal decision or cannot

be contacted after every reasonable effort has been made, I instruct a service provider who intends to provide personal services to me to follow the following instructions that are relevant to the decisions to be made:

6. Other information (optional)

Not applicable

Initials

I provide the following information to help my agent(s) understand my wishes, beliefs and values when making

decisions about my personal matters:

7. Who determines my capacity (optional)

Not applicable

Initials

 

I designate

,

 

 

 

 

 

name of individual(s)

to determine my capacity under section 9 of the PERSONAL DIRECTIVES ACT.

8. Notification (optional)

Not applicable

Initials

 

If a determination is made under the PERSONAL DIRECTIVES ACT that I lack capacity to make personal decisions, I instruct

 

 

 

the person making the determination to provide a copy of the declaration to me, the agent(s) I have designated in this Personal Directive, if any, and following people:

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9. Signatures

Signed by me in the presence of my witness at

 

 

 

 

, in the Province of Alberta,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

location

this

of

,

 

 

 

 

 

 

 

 

 

 

 

 

day

 

month

 

 

year

NOTES:

Witness should also initial provisions initialed by maker.

The following persons may not witness the signing of a Personal directive:

lA person designated in the directive as an agent

lThe spouse or adult interdependent partner of a person designated in the directive as an agent

lThe spouse or adult interdependent partner of maker

lA person who signs the directive on behalf of the maker l The spouse or adult interdependent partner of a person

who signs the directive on behalf of the maker

name of maker

 

signature of maker

address of maker

name of witness

 

signature of witness

address of witness

10. Acknowledgement (optional)

I (We) acknowledge that I (we) have received a copy of this personal directive.

 

 

 

 

 

 

Name of Agent

Signature of Agent

 

 

 

 

 

 

Location where signed

Date of Signing yyyy-mm-dd

 

 

 

 

 

 

 

 

Telephone Number of Agent

 

 

 

 

 

 

Address of Agent

 

 

 

Email Address of Agent

 

 

 

 

 

OPG5521 Rev. 2020-05

Page 4 of 4

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Filling out section 1 in personal directive alberta

2. After this array of fields is completed, go on to type in the applicable details in all these: Option Two, Initials, I designate the Public Guardian as, I have consulted with the Public, The Public Guardian has agreed to, Option Three, Initials, I do not wish to designate an, and provider who intends to provide.

Best ways to fill in personal directive alberta part 2

3. This 3rd step is quite easy, Option One, Initials, I give my agents the authority to, nonfinancial nature that relate to, OPG Rev, and Page of - all of these fields is required to be filled in here.

How to complete personal directive alberta stage 3

4. Now proceed to this fourth segment! In this case you'll get these Option Two, Initials, I give the following agents the, matters of a nonfinancial nature, Initials, Health Care, Initials, Accommodation, Initials, With whom I may live and associate, Initials, Participation in social activities, Initials, Participation in educational, and names of agents fields to do.

Writing segment 4 of personal directive alberta

5. When you near the finalization of this file, you will find a few more points to complete. Mainly, Initials, Participation in employment, Initials, Legal matters, Initials, Other personal matters, Describe other personal matters if, names of agents, names of agents, names of agents, names of agents, Designation of agent for, Not applicable, Initials, and I designate should be filled in.

Tips on how to fill in personal directive alberta portion 5

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