Advance Directives

Advance directive forms help your family and physician understand your healthcare wishes in the event you lose the ability to make your own decisions. There are several types of advance directives. Please click on the form you want from below. Print and fill out the form according to the enclosed instructions. Each document should be reviewed, completed, signed and copies given to your family, physician, other caregivers, and attorney.

Advance Directives Cover Letter

Your Right to Decide
Your Right to Decide in Spanish
Your Right to Decide is an informative brochure explain the purpose of advance directives.

Living Will Declaration
Living Will Declaration (Spanish)
A Living Will expresses whether a person would want life-sustaining procedures to be withheld or withdrawn if, at some future time, they are unable to decide whether any medical procedure or intervention should be accepted or rejected.

Life-Prolonging Procedures Declaration
A Life-Prolonging Declaration mandates the implementation of all life-prolonging procedures, which would extend life.

Power of Attorney and Appointment of a Healthcare Representative
Power of Attorney and Appointment of a Healthcare Representative (Spanish)
A Power of Attorney document appoints another person, called an agent, to make healthcare decisions in the event he or she becomes unable to make their own medical decisions. An Appointment for Healthcare Representative document appoints a healthcare representative to make medical decisions in the event he or she becomes incapacitated.

Indiana Do Not Resuscitate Declaration
A Do Not Resuscitate Declaration is a state specific form that specifies a persons desire to have cardiopulmonary resuscitation procedures withheld if experiencing cardiac or pulmonary failure.

Physicians Order for Scope of Treatment
This form is a physician's order for scope of treatment based on the patient's current medical condition and preferences.

Psychiatric Advance Directive
A Psychiatric Advance Directive (PAD) is a legal document with instructions about exactly what type of mental health treatments a person would prefer in an emergency.

If you have any questions pertaining to health information, please contact:

Woodlawn Hospital

Health Information Management

1400 E Ninth Street

Rochester, Indiana 46975

(574) 224-1140

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