Advance Health Care Directive (English and Spanish)

The Advance Health Care Directive is a legally binding form that lets you exercise your right to give instructions about your own health care and/or to name someone else to make health care decisions for you in the event you are unable to speak for yourself. If you use this form, you may complete or modify all or any part of it. You are free to use a different form. In any case, agents designated and signatures required must be done in the manner prescribed on this form and mandated by the California ... Read More

End of Life Values-Choices Checklist

English The End of Life Values-Choices Checklist is a form that lets you think about end of life choices and values, and commit them to writing. If you prefer, you can download the End of Life Values-Choices Checklist in Microsoft Word (.doc) format. Spanish The End of Life Values-Choices Checklist is a form that lets you think about end of life choices and values, and commit them to writing. If you prefer, you can download the End of Life Values-Choices Checklist in Microsoft Word (.doc) ... Read More

Go Wish Cards, Elizabeth S. Menkin, MD

Go Wish cards order information, Frequently Asked Questions and examples of clinical uses of these Values Sorting Cards helpful when considering end of life choices are provided at this site. The Go Wish cards were created by Elizabeth Menkin, MD and the CODA Alliance to simplify advance care planning choices and assist with setting goals of care. Now available in Spanish.

Visit Go Wish Cards, Elizabeth S. Menkin, MD

Medic Alert Bracelet

MedicAlert® is the leading personal health record repository for medical information with its famous Medic Alert bracelet and medical id alert necklaces recognized worldwide. Medic Alert bracelets and necklaces are used to inform emergency responders about medications, do not resuscitate orders and other information important if you are unable to speak for yourself.

Visit Medic Alert Bracelet

Physician Orders for Life-Sustaining Treatment (POLST)

Physician Orders for Life-Sustaining Treatment (POLST) is a document to help ensure that a patient’s wishes are known and honored toward the end of life. It uses a standardized medical order used to indicate which types of life-sustaining treatment a seriously ill patient wants or doesn’t want if his or her condition worsens. POLST assists health care providers and patients or their surrogate to develop a transferable care plan of desired interventions when dealing with serious, life-limiting ... Read More

Prehospital Do Not Resuscitate Form & Information

This form was developed by the CA Emergency Medical Services Authority, in concert with the CA Medical Association and emergency medical services (EMS) providers, for purposes of instructing EMS personnel to forego resuscitation attempts in the event of a patient's cardiopulmonary arrest. This form orders that no medical procedure be done to restart breathing or heart functioning if the heart stops beating or a person stops breathing. This form does not prevent a person from obtaining other emergency ... Read More

Thinking Ahead: My Way, My Choice, My Life at the End

This advance care planning workbook was designed by and for people with developmental disabilities to enable them to do their own advance care planning. A DVD video is also available and may be previewed online. This project was created by the California Coalition for Compassionate Care, the Board Resource Center and Mark Starford who has extensive experience and expertise in adapting complex information for persons with developmental disabilities. This is also a great resource to use when working ... Read More