To begin making your health care documents, we ask you to provide some basic identifying information about yourself. (We assume here that you are making documents for yourself. If that is not the case, enter the information for the person you are helping.)
You are asked to specify the state of your legal residence, sometimes called a domicile. This is the state where you make your home now and for the indefinite future. This information is essential, because the program produces health care directives that are geared to the laws of the state you select. (If you travel to another state, your document will be honored in that state as long as it meets the requirements of the state where you live.)
If you divide up the year living in two or more states, you may not be sure which state is your legal residence. To decide, choose the state where you are the most rooted—that is, the state in which you:
A health care document made in one state is usually valid in other states, too. Most states accept health care directives from other states as long as the documents are legally valid in the state where they were made. Some states limit reciprocity, however, accepting other states' documents only to the extent that they comply with their own laws. And a few states are silent about whether or not they will honor documents from other states.
It sounds complicated, but keep in mind that you have a constitutional right to direct your health care; states may not infringe upon that basic right. This means that your essential health care wishes—such as whether or not you want to receive life-sustaining treatment when close to death— will most likely be honored from state to state, whether or not your documents exactly comply with state law.
Rarely would you want to make a set of health care documents for more than one state. If your health care instructions for each state weren't absolutely identical, signing one document could simply revoke the other— whichever document was signed later would control. To make it even trickier, differences in state forms can make it almost impossible to prepare two sets of documents with identical directions.
If you spend a good deal of time in more than one state, do what you can to find out whether your home state's health care documents fully protect you in the second state. You may be able to get the information you need by speaking to a patient representative at a hospital in the second state—explain your situation and ask what they recommend. At minimum, you should be sure your home state's signature requirements— witnessing and notarization—cover the requirements for the second state, too. See State Witnessing and Notarizing Requirements.If they don't, ask an extra witness to sign or get your documents notarized so they are fully compliant with the requirements of both states.
If you don't feel confident that your health care wishes will be honored in both states where you spend time, ask an experienced estate planning lawyer for guidance.
Enter your name in the same form that you use on other formal documents, such as your driver's license or bank accounts. If you customarily use more than one name for official purposes, list all of them, separated by aka ("also known as").
There is room for you to list several names. But use your common sense. For purposes of your health care directive, your name is needed to identify you and to match you with your medical records. Be sure to include any names you have used on other medical documents such as prior hospital or doctor records.
Many states have restrictions or special considerations that may apply if a woman's health care directive takes effect while she is pregnant. If you are a woman, it may be necessary for you to answer a few more questions to address this possibility.
A few states ask you to provide more biographical information, such as your address or birthdate. If your state does, we will ask you for the additional information, and your documents will contain it, too.
Next, you can name a doctor to serve as your primary physician. This is the doctor who will:
You will probably want to name a primary physician if you already have an established relationship with a doctor you trust and with whom you have discussed—or will discuss—your health care wishes. (See "Talking to Your Doctor," below.)
If you don't have an established relationship with a doctor, you can skip to the next section of the program.
Your primary physician may be required to make important decisions about your mental state and your overall health. For example, your health care documents will take effect if you ever lack the capacity to make health care decisions for yourself, and somebody may need to decide whether or not that time has come. The doctor you name will be responsible for making the determination.
In addition, your health care documents may set out instructions for endoflife care in very specific situations—for instance, you may leave one set of instructions to take effect if you are permanently unconscious and another to govern your care if you are terminally ill. (You'll learn more about this in "Specifying Your Health Care Wishes," below.) Your primary physician will diagnose these conditions, putting your specific instructions into effect.
|Naming Non-Physician Primary Care Provders|
|In several states, the person who supervises your medical care doesn't have to be a doctor. Instead, the health care provider you name can be an advanced practice nurse (APN)* or a physician's assistant (PA), depending on the state. Other states are sure to follow this trend of recognizing that sometimes the provider who knows most about a person's condition is not a doctor.|
|State||Instead of a physician, you can name|
|Arkansas||APN, PA, or other "authorized independent healthcare provider"|
|New Hampshire||APN or PA|
|New Mexico||APN or PA|
|New York||APN or PA|
|Oregon||"Health Care Provider"|
|Utah||"Health Care Provider"|
|Vermont||APN or PA|
|Wisconsin||APN or PA|
|Wyoming||APN or PA|
If you have more than one doctor and you're not sure which one to pick, think about who would do the best job of supervising your overall care. This may be your family doctor or general practitioner, rather than a specialist.
If you're really on the fence, you can talk to each doctor you're considering. You may find that one of them seems more comfortable taking on the responsibility of managing your care or you might just get a better sense of whom to pick.
Another possibility is to name one doctor as your first choice and another as an alternate.
The program also asks you to name an alternate physician. Choose your alternate with the same care you use for your first pick. Keep in mind that this doctor may be responsible for making critical decisions about your care. If there isn't a second doctor you know and trust, skip this question.
It's wise to talk to your doctor about your treatment preferences before you finalize your health care documents. Talking with your primary physician (and alternate, if any) is especially important because your primary physician will be in charge of other caregivers. Make sure your doctor understands your health care wishes and is willing to follow them. If you have questions or concerns about specific treatments, your doctor should be able to answer them. If you have other, more subjective concerns about a particular medical condition, such as the effects of certain treatments or how the condition is likely to affect you, discuss those, too.
Let your doctor know that you are completing a health care directive. If you will name an agent, be sure your doctor knows how to contact that person in an emergency. Better still, introduce your agent to your doctor if you have not already done so.