Advance Directives

Download Advance Directives Forms in English or Español

Patients' rights and autonomy are the foundation of hospice. 

An Advance Directive is a statement that spells out how much or how little medical intervention a person desires.

A Medical Power of Attorney gives a person or persons of the patient's choosing, the right to make decisions concerning medical care and treatment should a patient become unable to do so for themselves.

With Advance Directives and Medical Power of Attorney in place, patients insure they will receive the treatment they want, and they save their loved ones from the anguish of second-guessing or acting without clarity.

If you are interested in attending a Houston Hospice sponsored workshop on Advance Directives, please email us at info@houstonhospice.org or call 713-467-7423.

Advance Directives Forms

English  l  Españolas

Consent to Medical Treatment
For a person who has not issued a directive and needs medical care. Does not include withholding or withdrawing life sustaining treatment.
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Declaration for Mental Health Treatment
This is an important legal document. It creates a declaration for mental health treatment.
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Directive To Physicians And Family Or Surrogates
This document allows individuals to inform their physician which, if any, artificial methods he/she would/would not want to be used to attempt to extend life.
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Medical Power of Attorney
This document allows an individual to appoint another person(s) to make health care treatment decisions for the individual. This document becomes effective only if the individual becomes incompetent or incapable of communication and does not permit the designee(s) to make decisions to supercede the patient's decisions.
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Out-of-Hospital Do Not Resuscitate Information and Form
This is an important legal document. This document becomes effective immediately on the date of execution. It remains in effect until the patient is pronounced dead by authorized medical or legal authority or the document is revoked.
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Procedure When Person Has Not Executed or Issued a Directive and Is Incompetent or Incapable of Communication
Note: May include withholding or withdrawing life sustaining treatment.
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Formas Españolas

Consentimiento de Tratamiento Médico
Para persona que no halla emitido directiva por adelantado y necesita tratamiento médico. Este formulario no incluye el rehuso o retiro de tratamiento médico.
View the pdf file in your browser.

Declaración para Tratamiento de Salud Mental
Este es un importante documento legal. Crea una declaración para el tratamiento de salud mental.
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Directiva a Los Médicos y a Familiares o Substitutos
Este documento permite a individuos informar a sus doctores si y cual o cuales metodos artificiales el individuo quisiera o no quisiera que se usen para tratar de extender la vida.
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Poder Legal para Asuntos Médicos
Este documento le permite a un individuo designar a otra persona (o personas) para que haga decisiones sobre el tratamiento médico del individuo. Este documento toma efecto solamente si el individuo llega a ser incompetente o incapable de comunicarse. A menos que el individuo declare lo contrario, la persona designada tiene la misma autoridad que el individuo para tomar decisiones sobre el cuidado de la salud del individuo.
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Procedimiento para Cuando una Persona no ha Ejecutado o Emitido una Directiva por Adelantado y es Incompetente o Incapable de Comunicarse.
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