ADVANCE DIRECTIVES FORMS

Click on the links below to download the Living Will, Medical Power of Attorney, and Combined Medical Power of Attorney/Living Will forms in a printable/viewable format. All forms are in Adobe Acrobat Reader

 

Living Will Form

Living Will Form (editable PDF)

Medical Power of Attorney Form

Medical Power of Attorney Form (editable PDF)

Combined Medical Power of Attorney and Living Will Form

Combined Medical Power of Attorney and Living Will Form (editable PDF)

Frequently Asked Questions Booklet about Advance Directive forms (includes forms)

Physician Orders for Scope of Treatment (POST) - SAMPLE

Do Not Resuscitate (DNR) Card - SAMPLE

Directions on How to Copy POST Form

 

NEW ADVANCE CARE PLANNING BULLETINS

DHHR Obligation to Serve as Health Care Surrogate

OHFLAC Memo Addressing DNR Issues

Warning Against Special Directive Attachment

 

LEGISLATION

Health Care Decisions Act

DNR Act

Management of Intractable Pain Act – H. B. 4275

Joint Policy Statement on Pain Management at the End of Life

H.B. 2815 (Continuing Education for End-of-Life Care)

Model Policy for the Use of Controlled Substances for the Treatment of Pain

H.B. 2839 Management of Pain Act

 

ADVANCE CARE PLANNING FORMS AND TOOLS

Assessing Decision-Making Capacity

Assessing Decision-Making Capacity Flowchart

Annotated Bibliography on Outcomes with Feeding Tubes

Job Description for Medical Power of Attorney Representative and Healthcare Surrogate in West Virginia

Mature Minor and Emancipated Minor

Family Conversations - How to Talk with Your Family and Friends About Future Health Care Decisions

POST Update: Respecting Patients’ Wishes at the End of Life

Possible Directives for the Special Directives or Limitations section of the Living Will

Surrogate Selection Checklist

Uniform Determination of Death