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Patient Services :: Advance DirectivesDownload Advance Directives Forms in English or in SpanishWherever we turn, we are confronted with issues surrounding end-of-life choices and wishes, bringing to the forefront the anguish and difficulties experienced by families and caregivers when they are not clearly understandable, written guidelines for how a person wants to be treated medically as he or she faces the end of life. Underlying each case is the attempt to understand and follow the family member's end-of-life wishes. Patients' rights and autonomy are the foundation of hospice. It is part of our mission to follow the wishes of the patients that are within our services. An Advance Directive is simply a statement that spells out how much or little medical intervention a person desires if he or she is facing a terminal illness or another end-of-life situation. The directive would be used if the time comes that the patient is no longer capable of making and articulating decisions. Generally speaking, the directive tells the physicians and family to either discontinue treatment except that which is necessary for comfort, or which treatments to continue. A person can write a directive to include interventions such as feeding tubes and other means of artificial hydration and nutrition, ventilators, dialysis and certain medications that may be considered life sustaining. Another patient right is the ability to designate a Medical Power of Attorney, which gives a person or persons of the patient's choosing, the right to make decisions concerning the medical care and treatment when the patient is no longer able to do this himself. This person should be someone known and trusted, and who will be available to the care providers. Our community is aware of the importance of planning ahead and creating the directives to guide and inform our loved ones of our wishes. It is in this way that we are more likely to receive the treatment that we want and not put our loved ones through the anguish of second-guessing or acting without clarity. If you are interested in attending a Houston Hospice sponsored workshop on Advance Directives, please e-mail us at info@houstonhospice.org or call 713 467-7423. Available Advance Directives forms
English SpanishConsent 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. View the pdf file in your browser. Declaration for Mental Health Treatment This is an important legal document. It creates a declaration for mental health treatment. View the pdf file in your browser. 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. View the pdf file in your browser. 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. View the pdf file in your browser. 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. View the pdf file in your browser. 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. View the pdf file in your browser. Spanish Forms Consentimiento de Tratamiento MedicoPara persona que no halla emitido directiva por adelantado y necesita tratamiento medico. Este formulario no incluye el rehuso o retiro de tratamiento medico. 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. View the pdf file in your browser. Directiva por Adelantado para Doctores y Familiares o Sustitutos 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. View the pdf file in your browser. 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. View the pdf file in your browser. Procedimiento para cuando una persona no ha ejecutado o emitido una Directiva por Adelantado y es incompetente o incapable de comunicarse. Nota: Podria incluir el rehuso o retiro de tratamiento de sustención de vida. View the pdf file in your browser.
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