Advanced Heathcare Directive Forms


An advance directive is established by completing an Advanced Health Care Directive form (click on your state below):

Advance Health Care Directive Form for Delaware 

For more detailed information in Delaware go to:  http://dhss.delaware.gov/dhss/dsaapd/advance.html                    

Advanced Health Care Directive Form for Pennsylvania

For more information in Pennsylvania go to: https://www.dhs.pa.gov/docs/For-Providers/Documents/Behavioral%20Health%20Services/Instructions%20%20Forms%20-%20English.pdf​

FAQ's

What is a power of attorney for health care?
An Advanced Health Care Directive Form allows you to name another individual as an "agent" to make health care decisions for you if you become incapable of making your own decisions.  It also enables you to name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you. This part of the form is a Power of Attorney for Health Care. 

Are advance directives mandatory?
Completing an Advance Health Care Directive form is strictly voluntary.  If you have not given advance instructions for your health care or have not named an agent in a health care power of attorney and you become unable to make your own decisions, a surrogate will be asked to make those decisions for you.

The persons listed below would be asked to assume the role of surrogate in the following order of priority:
  1. Spouse
  2. Adult child
  3. Parent
  4. Adult brother or sister
  5. Adult grandchild
  6. Niece or nephew
  7. An adult who has exhibited special care and concern for you, if appointed as guardian for that purpose by the Court of Chancery

What should I do with my advance directive?
You should retain your original completed and signed Advance Health Care Directive and give a copy of the form to your physician and to any other health care providers that you have.  You should also give a copy the person that you have named as your health care agent.  It would be a good idea talk to that person and make sure that he or she understands your wishes and is willing to take responsibility for ensuring that your wishes are honored.  In addition, you may want to give copies to other family members and close friends.

You have the right to revoke your advance health care directive or replace it at any time.