Patient Privacy Forms
- Authorization for Release of Health Information from Medical Record
- Pennsylvania Interscholastic Athletic Association Form for Sports Physicals
- Authorization for Proxy Access Form
- Patient Portal Enrollment Form
Health History Forms:
Your Right to Make Decisions Affecting Your Care – Advance Directives Form & Instructions
We encourage you to think in advance about what treatment you would accept or refuse if you had an end-stage medical condition or became permanently unconscious, and could not express your wishes. One way to make sure your wishes would be followed in such an event is to have written instructions, called advance healthcare directives that explain what kind of treatment you would want. Three types of advance healthcare directives related to healthcare choices are recognized in Pennsylvania: living wills; power of attorney for health care decisions; and combination documents. They are legal documents that enable healthcare personnel to obtain information about your wishes should you not be able to communicate. Usually, they are written in advance of serious illness and state your choices for health care, or name someone to make those choices if you become unable to make decisions.
TYPES OF ADVANCE HEALTHCARE DIRECTIVES IN PENNSYLVANIA
1. Living Will
A legal paper that spells out the kind of life-prolonging medical care you would want—or would not want—if you had an end-stage medical condition or became permanently unconscious and unable to make your own decisions.
2. Power of Attorney for Healthcare Decisions
A signed and dated document that gives another person the legal right to make decisions regarding your health care if you are not able to make such decisions yourself. This person will have access to your medical records.
3. Combination Document
A document that incorporates features of both a living will and a healthcare power of attorney.You may revoke an advance directive at any time.
Any changes or revocations should be signed and dated and you should give copies to your family and doctor.
ADVANCE HEALTHCARE DIRECTIVES GO INTO EFFECT ONLY UNDER CERTAIN CONDITIONS
It is important to know that an advance healthcare directive goes into effect when you are in our hospital only if Grand View has a copy of it. Please bring a copy of your advance healthcare directive with you every time you are admitted to Grand View. Also, give copies of your advance healthcare directive to your doctor and loved ones so your wishes would be known should you be admitted to the hospital unexpectedly.