Riverview Hospital is pleased to provide health information and documentation resources to you. A variety of forms and resources are provided below. These are in PDF format and can easily be printed, completed and utilized.Parental Consent for Medical Treatment
Health Information Request Form
What medical care would you want to receive if you were hurt or too ill to express your wishes?
Advance Directives are legal documents that communicate your decisions about your end-of-life care to family, friends, and health care professionals. An Advance Directive speaks for you if you are unable to speak for yourself.
If you have an Advance Directive, it is important to give a copy to your nurse and/or physician to keep with your medical record. This will ensure your Advance Directive preferences are communicated to healthcare professionals assisting with your care during your stay in the Hospital.
If choose to create an Advance Directive you will make your preferences about medical care known before you are faced with a serious injury or illness. An Advance Directive spares your loved ones the stress of making decisions about your care while you are sick. Any person 18 years of age or older can prepare an Advance Directive.
You may change or cancel your Advance Directive at any time, as long as you are considered to be of sound mind. Being of sound mind means you are able to think rationally and communicate your wishes in a clear manner. If you decide to change your Advance Directive, make sure your doctor and any family members who know about your Directive are aware of the change. Changes to your Advance Directive must be made in writing, signed, and notarized.
Are Advance Directives Required?
No, advance directives are not required. Your physician or hospital cannot require you to make an advance directive if you do not want one. No one may discriminate against you if you do not sign one. Physicians and hospitals often encourage patients to complete advance directive documents. The purpose is for your physician to gain information about your health care choices so that your wishes can be followed. While completing an advance directive provides guidance to your physician in the event that you are unable to communicate for yourself, you are not required to have one.
What Should I Do With My Advance Directive If I Choose To Have One?
Make sure that your health care representative, immediate family members, physician, attorney, and other health care providers know that you have an advance directive. Be sure to tell them where it is located. You should ask your physician and other health care providers to make your advance directives part of your permanent medical chart. If you have a power of attorney, you should give a copy of your advance directives to your attorney in fact. You may wish to keep a small card in your purse or wallet that states that you have an advance directive, where it is located, and who to contact for your attorney in fact or health care representative, if you have named one.
There are several types of Advance Directives. The type of Advance Directive you select is a personal choice. Samples are included below.
A health care representative is a person you choose to receive health care information and make health care decisions for you when you are unable to do so. To choose a health care representative, you must fill out an appointment of health care representative document that names the person you choose to act on your behalf. Your health care representative may agree to or refuse medical care and treatments when you are unable to make decisions for yourself. Your representative will make these choices based on your advance directive. If you want, in certain cases and in consultation with your physician, your health care representative may decide if food, water, or respiration should be given artificially as part of your medical care.
Life Prolonging Procedures Will Declaration
A Life Prolonging Procedures Will Declaration is a document that states you want all possible life-prolonging medical procedures, treatments, or interventions used to extend your life. A life-prolonging procedure includes mechanical or other artificial means to sustain, restore, or supplement vital functions. The Declaration includes administration of nutrition, hydration, and medication, as well as any medical procedure necessary to provide comfort or to alleviate pain.Life Prolonging Procedures
A Living Will describes the kind of medical treatments or life-sustaining treatments you do or do not want to receive if you become seriously or terminally ill. Living Wills may address issues such as your wish to be resuscitated (receive CPR) if you stop breathing or your heart stops beating; use of a mechanical breathing machine (ventilator), feeding tube, or dialysis machine; and organ or tissue donation. A Living Will does not let you select someone to make decisions for you.Living Will
If you need additional information or want to create an Advance Directive, contact your nurse, a discharge planner, nursing supervisor, or a department manager.
For More Information
395 Westfield Road
Noblesville, IN 46060
Toll Free: 800-523-6001
Physician Referral: 317-776-7450 Email: email@example.com
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