Advance Directives (Page 2 of 2) in pdf

Advance Directives Page 2

You will get more information on advance directives if you are admitted to a hospital. You are not

required to have one. If you decide to have an advance directive, it is important to talk to your provider.

You should also talk with family and people who are close to you. Be sure to give copies of your directive

to your provider, family members, and durable power of attorney (if you have one).

What Happens if Your Advance Directive Is Not Followed?

In the event that an attending physician or health care facility refuses to comply with an Advance

Directive on the basis of moral convictions, religious beliefs or other conscientious objections, the

individual will be transferred to the care of another health care provider willing to comply with the

Advance Directive.

 You can call BHI let us know about your concerns at: (303) 361 - 8100

 Call the Colorado Department of Public Health and Environment at (303) 692-2980

 Or write to: Colorado Department of Public Health and Environment 4300 Cherry Creek Drive

South Denver CO 80246-1530 or go to this website:

I have read and understand the information about advance directives provided to me.

☒

☐

I do not have advance directives

I do have advance directives and have given a copy to my provider.

_________________________

_____________

Client Signature

Date

__________________________

_____________

Clinician Name and Credentials

Date

Advance Directives Page 2