Disability Rights Center

Advance Directives for Planning Mental Health Care
	FORMS
	The sample forms that follow were developed by Disability Rights Center for people who want to develop an advance directive for mental health care. They are based on the Uniform Health Care Decisions Act. These forms don’t include language regarding general health care decisions. If you are going to use these forms, it may be better if you do not use Бу or X marks to select your choices, but write your initials instead. Form 1: Advance Directive, includes options for both Power of Attorney and Instructions Form 2: Doctor Certificate of Capacity Form 3: Wallet Cards

	Introduction
	What is an Advance Health Care Directive?
	How do I Give My Advance Health Care Instructions?
	What Is A Power Of Attorney?
	How do I Name My Agent?
	Are There Advantages to Having Both A Power Of Attorney and Health Care Instructions?
	When Do I Have Capacity To Write My Instructions and Power Of Attorney?
	Do I Need To Include Proof of My Capacity with the Document?
	When Would My Advance Directive Take Effect?
	If I Choose to Have My Advance Directive Become Effective at Some Time other that When I am Determined Incapacitated, will that Affect How My Instructions are Carried Out?
	How Will I Be Determined Incapacitated?
	If a Guardian is Appointed for me after I write an Advance Directive, Does the Guardian Have To Follow My Instructions?
	Can I Change or Revoke My Instructions or Power Of Attorney?
	What Types of Instructions Might I Include In the Directive?
	What Do I Need To Do To Get My Instructions Carried Out?
	Do Health Care Providers Have to Follow My Instructions?
	How Might My Instructions Otherwise Be Challenged?
	How do my Instructions Affect Involuntary Treatment?
	What Can I Do If My Health Care Instructions Aren't Being Followed?
	Conclusion
	FORMS
	Form 1 - Advance Directive
	Form 2 - Certificate of Capacity
	Form 3 - Wallet Card
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Form 2: Doctor Certificate of Capacity