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Massachusetts Advance Health Care Directive Form

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Massachusetts Advance Health Care Directive Form Page 2
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Using these Materials
BEFORE YOU BEGIN
1. Check to be sure that you have the materials for each state in which you may receive
health care.
2. These materials include:
Instructions for preparing your advance directive, please read all the
instructions.
Your state-specific advance directive forms, which are the pages with the gray
instruction bar on the left side.
ACTION STEPS
1. You may want to photocopy or print a second set of these forms before you start so
you will have a clean copy if you need to start over.
2. When you begin to fill out the forms, refer to the gray instruction bars they will
guide you through the process.
3. Talk with your family, friends, and physicians about your advance directive. Be sure
the person you appoint to make decisions on your behalf understands your wishes.
4. Once the form is completed and signed, photocopy the form and give it to the person
you have appointed to make decisions on your behalf, your family, friends, health care
providers and/or faith leaders so that the form is available in the event of an
emergency.
5. You may also want to save a copy of your form in an online personal health records
application, program, or service that allows you to share your medical documents with
your physicians, family, and others who you want to take an active role in your
advance care planning.
Massachusetts Advance Health Care Directive Form