Salinas Valley Memorial Hospital utilizes an Advance Directive for Healthcare form that incorporates a Durable Power of Attorney for Healthcare and Living Will information. A Durable Power of Attorney lets you name a person as your agent to make decisions on your behalf should you be unable to do so.
Specially trained volunteers are available to assist patients and visitors with Advance Directives. Call 755-0772 to schedule an appointment.
Download the Advance Directive forms:
"5 Wishes" is a legal document allowing you to identify healthcare wishes at a time of serious illness. The document presents the opportunity to identify issues related to physical, emotional and spiritual well-being as it pertains to your medical needs.
Download 5 Wishes:
Physician's Order for Life Sustaining Treatment
The Physician's Order for Life Sustaining Treatment (POLST) is a physician based order that is to be completed with your medical team to assist with end of life care. Reminder: This document is available for review only; if interested in its completion, please ask your doctor/medical team.
Download The Physician's Order for Life Sustaining Treatment (POLST):
Making the Right Decision for You
The first step is to think about what is important to you in your life.
- Understand what each type of treatment can and cannot do and choose the treatment(s) you want. If you don't want treatment, that's okay, too. The final decision will be based on your health and expected outcome of your treatment.
- Accidents do happen and injury and illness can strike at any time.
- An Advance Directive is important for any age person and can be changed at any time.
You can choose from three categories of care when your life is in danger:
- Life Supporting — Keeps your lungs breathing and your heart beating when they can't work on their own. This includes CPR, which tries to restart your heart and lungs if they have stopped and artificial respirators, which pump air into your lungs.
- Life Sustaining — Keeps you alive longer than you would be without the treatment when you have an incurable illness. These types of treatments include dialysis or tube feeding.
- Life Enhancing — Keeps pain under control. No Life Supporting or Life Sustaining treatments are given. Treatments include pain medication or hospice care.
If you need more information about treatment options available, be sure to speak with your physician.
Do You Want CPR?
If your heart and lungs stop working, would you want CPR (cardio-pulmonary resuscitation)? If not, be sure to speak to your physician and family about a Do Not Resuscitate (DNR) Order. Caution: Do Not Resuscitate Orders and Advance Directives may not be recognized by emergency personnel on an emergency call or in an emergency room. Make sure your family and physician know your wishes.
Choosing Your Durable Power of Attorney
This person you designate as your Durable Power of Attorney:
- Sees that your wishes are carried out.
- Is allowed to make choices about your health care.
- Has no control over your finances and cannot be held accountable for your bills.
Remember to choose someone who Is at least 18 years old, knows what is important to you and you trust to represent and stand up for your wishes.
Advance Care Planning and a Living Will lets you define the treatment choices you want. It is used only should you be unable to express your desires. It is important that you consider your treatment options so you can make the right decision for you.
Completing the Advance Directive Forms
After you choose options and you know who will speak on your behalf, complete an Advance Directive to ensure that everything is legal. Forms are available at the Main Reception Desk at Salinas Valley Memorial Hospital. All forms must be filled out completely, signed and witnessed to be legal. Witnesses can be a notary public or, in our hospital, Service League Volunteers are here to provide this service. Send copies to the following:
- Your physician
- Your designated agent
- Family members
- Hospital (bring with you when you are being admitted)
Keep the original in an unlocked place where it can be easily accessed in case of an emergency.