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.