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Advance Care Planning 

Preparing for the “what ifs’ in life will ensure I received the care I want. When I am prepare those who may be in a position to make decision on my behalf will also be prepared

 Think and Learn

☐  my wishes and values and how they may influence my future health care decisions

☐  current health issues and decisions that may need to be made.  

☐  previous experiences with my own health or of others and how this may impact future health care choice for myself.

☐  advance care planning terms and medical procedures 

☐ I have contemplated what quality of living means to me.

Tip: QLP “Let’s Learn” Tab can help you to complete this section

Tip: QLP FAQ and “Let’s Talk” tab can help you to complete this section

Decide and Starting The Conversation

☐  Chose who will make medical, shelter and personal decisions on my behalf if I am not able to make these decisions from myself. (Substitute Decision Maker)

☐ Identified an alternate person in case my first choice is unable to fulfill this role.

☐ discussed my health, shelter and personal care preferences with my Substitute  Decision Maker and those closest to me including my health care professionals.


☐ Created an Advance Health Care plan and/or a Health Care Directive

☐ Completed Power of Attorney for Personal Care documents and provided  my Power of Attorney for Personal Care a copy of my Advance Health Care  Directive.

☐  Provided a copy of my AHCD and discussed who will be making decisions  on my behalf with my family and doctors.

Tip: QLP “Let’s Interact” tab can help you complete this section.

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