Download Advance Health Care Directive

ADVANCE HEALTH CARE DIRECTIVE
Take charge of your health care and help
ensure that your wishes will be honored.
In the event that you are not able to
communicate your wishes, an advance
directive can help do that!
ADVANCE HEALTH
CARE DIRECTIVE
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for adults
At Kaiser Permanente, we support your
right to make decisions regarding your
health care. In fact, we encourage you
to make these important decisions now,
when you are healthy, with a written
document called an Advance Directive.
By putting your wishes in writing, your
family and health care providers will know
what you want if you become unable to
make decisions for yourself. And, by clarifying your wishes at a time when you are
able to think clearly about them, you free
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decisions for you.
INFORMATION WHEN YOU NEED IT! –
kp.org
Valuable information is available to you, 24/7.
Check out our Website at your convenience to
learn more about advance health care directives.
Go to kp.org and search:
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The Patient Self Determination Act of December 1991 requests
that hospitals and other health care providers inform patients
about their rights regarding Advance Health Care Directives.
kp.org
0005 6623 3/11
ADVANCE HEALTH
CARE DIRECTIVE
END OF LIFE DECISIONS
You have the right to give instructions about your
own health care. You may express your wishes
regarding the provision, withholding, or withdrawal
of treatment to keep you alive. These include
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Discuss these important decisions with your family
and doctor.
HEALTH CARE POWER OF ATTORNEY
The Health Care Power of Attorney allows you to
name an individual as your agent to make health
care decisions for you. You may choose to have
your agent make decisions for you immediately or
only when you become incapable of making your
own decisions.
You may name an alternate agent to act for you
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make decisions for you. Unless related to you, your
agent may not be an owner, operator, or employee
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in details with your agent and your family.
Your completed document will be available 24
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the Advance Health Care Directive, it will help your
family by freeing them of the responsibility to make
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...giving you peace of mind
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PRODUCTS FOR ADULTS
If you have beliefs or other reasons that prohibit the
use of blood and blood products, there is a form
available, upon request, for you to sign requesting
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Permanente. Let your physician know of these wishes.
ORGAN AND TISSUE DONATIONS
One of the greatest gifts you can give is to donate
your organs for transplant when you die. The need is
great. There are thousands of seriously ill individuals
nationwide waiting for organ donations, including
hundreds in Hawaii. Your heart could save the life
of a young mother with cardiovascular disease.
Your corneas could help a grandmother see her
grandchildren clearly. And, your kidneys could free
two people from a lifetime of dialysis treatments.
Organs and tissues that can be donated include:
WE’RE HERE TO SUPPORT YOU!
To receive an Advance Directive form,
contact Customer Service at:
1-808-432-5955 (Oahu)
1-800-966-5955 (Neighbor islands toll free)
1-877-447-5990 (Toll free TTY)
If you have any questions or need assistance
in completing the form, contact the Social
Services Department:
Heart, heart valve, liver, kidney, lung, pancreas,
cornea and bone.
1-808-432-7100 (Oahu & other neighbor
island)
It is important to tell your family and physician of
your wishes to donate organs or tissue so that your
family can honor your decision. Your family must
give permission. Without it, your organs and tissues
cannot be donated.
1-808-243-6690 or 1-808-243-6692
(Maui)
For more information, contact the Legacy of Life, at
808-599-7630.
Classes on Advance Directives may be
offered. Contact the Prevention & Health
Education Department.
1-808-432-2260 (Oahu & other neighbor
islands)
1-808-243-6484 (Maui)