Advance Care Planning

Advance Directives for Adults

Advance Directives are legal documents that let others know what type of medical care you want. They will be used if you become too ill to participate in medical decisions. You do not need a lawyer to complete any of these forms. 

Please contact our Social Work department at 216-778-5551 if you have any questions or need help with the forms.

Once you have completed your Advance Directive(s):

  • Give copies to those you trust. 
  • Give copies to your medical provider. 
  • Bring copies with you to the hospital. 
  • Upload them to MyChart

 

Most Popular Advance Directives

Health Care Power of Attorney

This document allows you to name someone who will talk to your medical team when you can’t talk to them yourself. This individual is sometimes called a surrogate or proxy. They should tell the team what you want and what you don’t want. Choose someone you trust and discuss your medical wishes with them.

View Health Care Power of Attorney Document (PDF)

 

Declaration for Mental Health Treatment

This document allows you to name someone who will talk to your medical team about your mental health care when you can’t talk to them yourself. This individual is sometimes called a surrogate or proxy. They should tell the team what you want and what you don’t want.

Choose someone you trust and discuss your medical wishes with them. The document also allows you to share your wishes about mental health treatments such as medications and therapy, including electro-convulsive therapy. 

View Declaration for Mental Health Treatment Document (PDF)

If you do not name someone as your Health Care Power of Attorney or as your proxy in the Declaration for Mental Health Treatment, the medical team will talk to your family in the following order: spouse, adult children, parents, siblings, closest adult relative by blood or adoption.

 

Living Will

This document allows you to share your wishes about life-prolonging treatments like breathing machines and feeding tubes. Discuss your wishes with your Health Care Power of Attorney if you have one. If you do not have a Health Care Power of Attorney, talk to someone you trust.

Note: The Living Will document is located on page 25 of the following PDF. You do not have to complete the entire Health Care Power of Attorney document in order to complete a Living Will.

View Living Will Document (PDF) 

 

Organ Donation Form

This document allows you to share your wishes regarding organ donation for transplantation, therapy, research, and education. Discuss your wishes with your Health Care Power of Attorney or Successor (see below). If you do not have a Health Care Power of Attorney or Successor, talk to someone you trust.

Note: The Organ Donation Form is located on page 37 of the following PDF. You do not have to complete the entire Health Care Power of Attorney document in order to complete an Organ Donation Form.

View Organ Donation Form (PDF)

Some religions have their own Advance Directives that you may choose to complete. You should contact your religious authority for further information. 

 

Other Important Documents

Do Not Resuscitate Orders

These are medical orders that tell your medical team that you do not want treatments if your heart stops beating or you stop breathing. The order must be signed by a physician, advance practice registered nurse, or a physician’s assistant. You do not need a lawyer to complete this form. Contact your primary care provider if you have questions about this order.

View Do Not Resuscitate Form (PDF)

 

Disposition of Bodily Remains, Funeral Arrangements, and Burial or Cremation Goods and Services

This form allows you to name someone to oversee the disposition of your body upon your death. This person is called your successor.

Choose someone you trust and discuss your wishes with them. It also allows you to share your wishes about your funeral, memorial services, and religious observances. You do not need a lawyer to complete this form. 

View Form (PDF)

If you do not name someone as your Successor in the Disposition of Bodily Remains form, the medical team will talk to your family in the following order: spouse, adult children, parents, siblings, grandparents, grandchildren, lineal descendants of decedent’s grandparents, the guardian if there was one, any other person willing to assume the right of disposition.