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Advance Care Planning FAQs

Find answers to frequently asked advance care planning questions

Do I need to fill out an Advance Directive?

A written Advance Directive is recommended for everyone 18 years of age and older regardless of their current health status. An advance directive is the best possible way to be sure that decisions regarding your future medical care will reflect your own wishes if you are unable to speak for yourself. Putting your wishes in writing also helps avoid confusion or conflict in times of crisis or uncertainty.

What goes into an Advance Directive?

An Advance Directive (AD) is a legal document which can direct the care of the medical team in an urgent medical situation. It reflects your wishes regarding medical care in the event of an unexpected illness or injury. Advance Directives include both a Living Will, or Heath Care Directive, and the Durable Power of Attorney for Health Care (DPOAH). The DPOAH allows you to choose someone you trust as your healthcare agent. The agent is the person/s you choose to speak for you if you can’t speak for yourself.

What is the difference between an Advance Directive and POLST forms?

A POLST (Portable Order for Life Sustaining Treatment) is a medical order that healthcare workers, including EMS, can base their actions on. This portable medical order allows patients who are seriously ill or frail to voluntarily approach end of life planning in a way that honors and documents their wishes. It helps Emergency responders to have a quick and clear document to refer to without having to look through an entire Advance Directive. A POLST does not replace an Advance Directive. They work together. If you have a POLST form, you should be sure your Advance Directive reflects your same choices for care.

A completed and signed POLST form is highly recommended if you wish to be DNR (Do Not Resuscitate) or no cardiopulmonary resuscitation (CPR). This brightly colored form should be posted in a visible place in your home, often on the refrigerator, near your phone or at the bedside of a person who is mostly bedbound.

Do I need my Advance Directive Notarized?

Advance Directives in many states can be either witnessed or notarized. Its important that you read your advance directive to identify any restrictions on who can witness the document. If you are unable to find two people to witness the document you can have it notarized instead. Please feel free to contact our team regarding questions.

Why do I need a Healthcare agent?

In a medical emergency the people who are providing your care do not know you. They do not know your history, your goals or wishes for care. Having a trusted and strong healthcare agent who can speak on your behalf is invaluable. They can advocate for you and help make difficult decisions based on the conversations you have had with them before an event occurs.

How do I choose a Healthcare agent?

If you are unable to make medical decisions, this person speaks to doctors/healthcare team on your behalf.   Your healthcare agent does not have to be a family member, spouse, or partner. In some cases, it is better to ask a person who you trust will honor your wishes rather than a family member. Choosing someone who is not a family member, spouse, or partner may also relieve your loved one of a responsibility he or she may be emotionally unable to assume.

Choose someone:

  • Who listens closely to your concerns and hopes regarding end of life or serious illness.
  • When needed, will articulate your wishes to other family members and those treating you. 
  • Who will stay level headed and respect your wishes. 
  • Who is willing to take on these responsibilities. 
What if I do not have a healthcare agent and become unable to speak for myself?

If you cannot make medical decisions for yourself and do not choose a health care agent, your doctors will follow state law to find a decision maker for you. State law authorizes the following people, in order of priority, to make health care decisions for you. 

State Hierarchies


Will my advance directive and wishes be honored if I go out of state?

All 50 states (and the District of Columbia) generally recognize the use of advance directives. When you travel, you should bring copies of your health care documents to make them easily accessible if an accident or unexpected illness occurs.

Can advance directives include information regarding cultural or religious beliefs that are important to me?

Yes, these are your wishes. We suggest you consider the important role that culture, beliefs and values play in determining what you would want for end-of-life care and be sure to include this in your conversations and in your document. If English is not your primary language, please ask your healthcare provider to provide an interpreter to assist you in understanding and completing your advance directive. 

Do I need to have an attorney prepare these forms for me?

There is no requirement that an attorney assist you in preparing your Advance Directives. If you have had a Living Will written up by an attorney it is strongly encouraged that you review this document and be sure it is clear and that your wishes can be easily understood.

What happens if I change my mind about what I want after I have completed the advance directive form?

We recommend you review and update your advance directive every 10 years, or if one of the “five D’s” occurs: Diagnosis, Disability, Divorce, Decade, Death of a Healthcare Agent. You can change your mind at any time and update or revoke your Advance Directive. This is always about what you want. The important thing to remember is to give your updated form to those who have access to your previously completed documents.

Can I indicate that I'm an organ donor on my Advance Directive?

Yes, you can. The advance directives for AK, OR and WA do not have a specific place for this information but it is OK to include it in the spaces provided for you to write in additional info. Also be sure your donor wishes are reflected on your driver's license and up to date at these registries: LifeCenter Northwest (for AK and WA) and Donate Life Northwest (for OR).

The forms are completed, now what?

Make several copies of your completed Advance Directive form. Be sure your health care agent/s have a copy and understand your wishes. Give a copy to your doctor. Be sure to put a copy of your Advance Directive on file at your local Hospital.  Send a copy to file with PeaceHealth Medical records by mailing to:

Attention: Health Information Management (HIM)
1115 SE 164th Avenue, Dept. 336
Vancouver, WA 98683

Or fax to 360-729-3444


*Please include a brief note (a sticky note will do!) requesting that the document be scanned into your medical record. If you do not have a current patient file, please include your birthdate, phone number and address with the form so that a record can be created exclusively for your Advance Directive.