Information About Advance Directives

An advance directive is a form where you can write down what type of care you want, or whom you want to make those decisions for you, if you cannot make those decisions for yourself. There are many kinds of advance directives with different names such as a “Health Care Power of Attorney,” “Patient Advocate Designation” or a “Do Not Resuscitate Order.” The form linked below is called a “Patient Advocate Designation.” This form lets you select a person, called your “Patient Advocate.” A patient advocate carries out your wishes or makes decisions about your care, but only when you are so ill or injured that you cannot make your own treatment decisions.

You have the opportunity to complete an advance directive and send it to a statewide registry called Peace of Mind.  The registry can be accessed online at, or call 1-800-482-4881.

Patient Advocate Designation form (DCH-3916)    PDF    MS Word (fillable)

Frequently Asked Questions about a Patient Advocate Designation