Think and Learn
☐ I have thought about my wishes and values and how they may influence future health care decisions.
☐ I have considered any current health issues and decisions that may need to be made.
☐ I have reflected on previous experiences with my own health or of others and how this may impact future health care choices for myself.
☐ I have sought out information on advance care planning terms and medical procedures (such as resuscitative measures, breathing tubes, artificial feeding, and life sustaining measures)
☐ I have contemplated what quality vs. quantity means to me.
☐ I have considered organ and tissue donation.
☐ I have considered housing options as I age.
☐ I have done an environmental scan to determine if I could remain in my home as I age.
☐ I have considered my personal hygiene preferences and how I wish others to care for me.
Decide and Starting The Conversation
☐ I have chosen who will make medical, shelter and personal decisions on my behalf if I am not able to make these decisions by myself. This person will be my Substitute Decision Maker.
☐ I have identified an alternate person in case my first choice is unable to fulfill this role.
☐ I have discussed my health, shelter, and personal care preferences with my Substitute Decision Maker and those closest to me including my health care professionals.
Documenting
☐ I have completed the process of advance care planning and documented my wishes in Advance Health Care Directives
☐ I have appointed a Power of Attorney for Personal Care to be my Substitute Decision Maker.
☐ I have provided my Power of Attorney for Personal Care a copy of my Advance Health Care Directives.
☐ I have provided a copy of my Advance Health Care Directives to my POA for personal care and property, significant family members, and my primary health care provider.