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Reported
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AD pref despite mental stte Reported
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Role religion faith culture spirit Rptd
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Support pal care team pref Reported
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Health info unable interact Reported
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Reported
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Reported
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Reported
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GPP Healthcare Agent Reported
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Thghts organ tissue dntns Reported
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Thoughts regarding autopsy Reported
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Thoughts on intubation Reported
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Thoughts on tube feeding Reported
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Thoughts on IV fluid+support Reported
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Thoughts on antibiotics Reported
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Thoughts on resuscitation Reported
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Circum activate agent's powers Reported
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HC agent appt jrsdctn Reported
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Healthcare agent advisor Reported
?
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Agent authority re PHI Reported
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Agent auth re protected PHI Reported
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Limitations on healthcare agent Reported
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Consent deviate from stated GPP Reported
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Compensation healthcare agent Reported
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Thghts life-sus px preg Reported
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Thoughts pain management Reported
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DNR, DNAR, or AND exists Reported
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Thoughts hastening death Reported
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Prescribed anticipatory medication Repor
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Loc of anticipatory medication Reported
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Near death thghts+feelings Reported
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My likes and joys Reported
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Things that make me laugh Reported
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My dislikes and fears Reported
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Things that matter to me Reported
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Religious/cultural beliefs Reported
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Religious/cultural aff contact Reported
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Unfinished business Reported
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Death arrangements Reported
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Messages delivered after death Reported
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Person(s) to notify upon death Reported
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Signer for declarant Reported
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Statement of doc creator Reported
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Statement of witness Witness Reported
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First witness
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Second witness
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Third witness
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Notary
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Notary commission expiration date
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Notary seal ID
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Health status Reported
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Mental health tx preferences Reported
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GPP certain health conditions Reported
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MOLST, POLST or similar exists Reported
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GPP for care experience Reported
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GPP upon death Reported
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Admin info for Advance Care Plan
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Goals +or pref priority Reported
?
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Thghts art nutrit hydration Reported
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Other directives not documented Reported
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Primary HC agent
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First Alt HC agent
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Second Alt HC agent
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Powers granted to HC agent Reported
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Request for resuscitation not CPR
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Request for intubation
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Request for tube feeding
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request IV fluid support
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Request for life support
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Request for antibiotics
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