Notice of Policy Regarding Advance Directives
This Facility requires the Policy Regarding Advance Directives notice be signed by each patient prior to scheduled procedure in order to be in compliance with the Self-Determination Act (PSDA) and State law and rules regarding advance directives. Advance directives are statements that indicate the type of medical treatment wanted or not wanted in the event an individual is unable to make those determinations and who is authorized to make those decisions. The advance directives are made and witnessed prior to serious illness or injury.
There are many types of advance directives, but the two most common forms are:
These generally state the type of medical care an individual wants or does not want if he/she becomes unable to make his/her own decisions.
Durable Power of Attorney for Health Care
This is a signed, dated, and witnessed paper naming another person as an individual's agent or proxy to make medical decisions for that individual if he/she should become unable to make his/her own decisions.
In the ambulatory care setting, if a patient should suffer a cardiac or respiratory arrest or other life-threatening situation, the signed consent implies consent for resuscitation and transfer to higher level of care. Therefore, in accordance with federal and state law, the facility is notifying you it will not honor previously signed advance directives for any patient. If you disagree, you must address this issue with your physician or anesthesiologist prior to signing this form.