My Advance Care Plan
Download a blank fillable My Advance Care Plan in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete My Advance Care Plan with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
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4Surname: ___________________________
First Name/s: ________________________
NHI Number: _________ DOB: __ / __ / __
Address: ___________________________
__________________________________
Phone: __________ Mobile: ____________
MY ADVANCE CARE PLAN
If you have had a chance to think about the care you want towards the end of your life,
you may want to write your thoughts down.
Use this plan to write down what you want health professionals, friends and family/
wh
nau to know if you could no longer tell them yourself.
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There is a section on medical treatments which is important to discuss with your doctor
if possible, before you complete it.
This plan is for you and about you. Complete as much as you want. You can show it to
anyone involved in your healthcare.
You can add to it as often as you like and change your decisions at any time.
Please take it to your doctors or nurses to discuss it and then you can both have copies.
It can be forwarded through your doctor to others who may need it, with your consent.
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Parent category: Medical