Order advance directive forms in English from DHS:  email at Bill.Gulick@OKDHS.org; phone 1-877-283-4113 or 405-962-1721.



APPOINTMENT OF HEALTH CARE PROXY

If my attending physician and another physician determine that I am no longer able to make decisions regarding my health care, I direct my attending physician and other health care providers pursuant to the Oklahoma Advance Directive Act to follow the instructions of _____________________________, whom I appoint as my health care proxy. If my health care proxy is unable or unwilling to serve, I appoint _________________________________as my alternate health care proxy with the same authority. My health care proxy or alternate health care proxy is authorized to make whatever health care decisions I could make if I were able regarding medical treatment, including life-sustaining treatment and artificially administered nutrition and hydration, based on what my health care proxy determines would be my wishes under the circumstances. If I have left part or the entire Living Will section blank, I do so with the intent of delegating the decision(s) to my health care proxy.

 

Signed this ___ day of _____________________, 20 ___.

_____________________________________________
Patient Signature
Oklahoma City, Oklahoma

_____________________________________________
Date of birth (Optional for identification purposes)

This Appointment of Health Care Proxy was signed in my presence.


_____________________________________________
Signature of Witness


_____________________________________________
Signature of Witness

FAQs

Why should you read this NOW?
1. By reading this website (instead of People magazine) you have made an important decision. You are finally ready to think about some hard choices. Why have you decided that today is the day to think about what’s going to happen just before the end of your life? Because if you’re reading this you can still think and you know that life is short.

If YOU don’t want to think about it, who does?
2. Would your family, close friends, or health care providers, know what kind of care you would like to receive, if due to an accident (ever notice that accidents are never planned?) or life-threatening illness (who has a pencil and paper when a massive heart attack strikes?) you were unable to make health care decisions for yourself and communicate them to (you hope!) an interested bystander?

And, what’s the chance that all those people who can’t agree on where to have Thanksgiving dinner will agree on what to do with you?
3. So, why would you leave it to the turkeys! Do what you can do NOW to make sure that you will receive the kind of care YOU want even when you can’t make treatment decisions for yourself.

Courts love to make decisions. Why not quit reading now and just leave it to your spouse, children, parents, a bunch of lawyers, and a judge?
4. For example, under what conditions would you 1) not want to be revived if your heart stopped, or 2) not want to have machines breathe for you, or 3) not want to be given food and water to be kept alive if you could not eat or drink on your own? Keep in mind that oral communications alone may not be sufficient - a written direction may be more effective. If you don’t like lawyers (and who does?), you can finally avoid them once and for all time!

After you write down your plans for the last road trip, you’re gonna hide that little piece of paper in a safe place, so no one can find it until after the funeral amongst all your other stuff in the big garage sale, right? How many times have you told those kids to do something and they actually remembered what you said?
5. It is vitally important to give copies of any document that expresses your end-of-life care wishes to your doctor, your local hospital and any family members or friends who may be called upon to make decisions for you.

SO, get ready, get set, take off . . .

First, take TWA to arrive at your advance care planning:

  1. TALK to your health provider, relatives and friends about issues that are important to you.
  1. WRITE your wishes. The document that contains your wishes regarding health care related matters is often called an advance directive. Some people may call this document a living will. In an advance directive, you can state your wishes about health care related issues and can also include wishes about who you want to carry out those decisions. It’s really very easy. You can complete the form included here or, if you want more information , Oklahoma has a snappy little website with all sorts of bells and whistles for your planning pleasure. Just go to www.okpalliative-care.com.
  1. APPOINT someone you trust (how rare is that?) to make health care decisions for you when you no longer can. The person you choose to make decisions for you is your “health care proxy”. You can name this person in the advance directive form and then fill out the wallet card on the back of this brochure.
MORE SERIOUS STUFF:

What is an advance directive?
6.. An advance directive includes: an oral or written statement of your wishes for the future, usually related to health care decisions; and a written designation of a proxy to make health-care decisions for you.

Who can make an advance care directive?
7. Any person who has the capacity to make decisions for himself or herself and who is at least 18 years of can execute an advance directive and appoint a health care proxy to make medical decisions.

When is it effective?
8. An advance health-care directive will take effect when a person's health-care provider (primary physician) and one other physician determine that the person can no longer make their own medical decisions. The new legislation requires only that two physicians certify that a patient no longer has ability to make medical decisions for themselves. This change from certification that the patient was terminally ill or in a persistent vegetative state was in keeping with the Constitutional requirement that anyone can refuse medical treatment and can refuse such treatment in advance of incapacity to make that decision.

How long does the advance directive last?
9. An advance directive lasts until the time of your death unless you revoke it sooner.

How do I revoke an advance directive?
10. You can revoke an advance directive, at anytime and in any manner that communicates intent to revoke the advance directive. You do not need to do this in writing. For example, you can destroy the directive.

What happens if I don’t plan my advance health care?
11. The law in Oklahoma presumes that you want cardiac resuscitation if your heart stops. It also assumes that you want artificially administered hydration and nutrition if you haven’t made your wishes known to the contrary when you were competent. So, if you fail to plan advance care, health providers are bound by these laws.

What if I don’t appoint a health care proxy?
12. f you fail to appoint a person you trust to speak for you when you are no longer able to communicate your wishes for health care there is a hierarchy of persons who may make health decisions, but that may not be the person you would trust to make your decisions.

What if I am not quite ready to make all of these difficult choices for myself?
13. You should definitely appoint someone that you trust to make the decisions for you if you are suddenly incapacitated and can’t speak for yourself. This avoids confusion between your health providers, family and friends as to who you want to make these important decisions. You should also be sure to talk to your proxy and let them know how you feel about cardiac resuscitation and artificially administered hydration and nutrition.

After all of this reading and thinking and great planning, it would be a real waste of your time to live forever.

Hospice Care:

14. You can insert language in your advance directive about WHERE you want to die too. Most of us want to die at home.

Most people would prefer to live, but if we have to die, most of us would like to die at home, in the company of family and friends and free of pain. In many cases, hospice care makes this possible.

Hospice care provides services to individuals and families during the process of dying and bereavement. Hospice care is meant to help meet the physical, social, psychological, spiritual and emotional needs of individuals and families during this very difficult time. The medical and non-medical services are delivered in the least restrictive setting possible. In most cases professionals, the family and volunteers provide these services in the home setting.

Hospice medical services focus on palliative care (control of symptoms and management of pain) rather than intensive, curative care. Hospice medical services are delivered by a team of individuals working with the individual's primary care physician.

A network of trained volunteers provides some of the non-medical services. Services can include transportation to medical appointments, respite care to allow family members to take brief breaks, and meal preparation. Hospice care is a service that can be paid for by private insurance, Medicare or Medicare.

More Useful Information

Other useful forms are available to help you express your wishes. For example, you can use a form to direct health providers to allow your natural death if you don't want cardiac resuscitation should your heart stop. You should discuss this decision with your health provider and family before you complete it.  Download Do-Not-Resuscitate Consent Form.

Some organizations, like the Center for Practical Bioethics, allow you to download, at no cost, other advance directive forms that are valid in Oklahoma.

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