Get Values History Form

The Values History Form is an important document that allows individuals to articulate their health care values and preferences. This guide will provide user-friendly steps for filling out the form online to ensure that your wishes are clearly expressed for your future health care decisions.

Follow the steps to complete the Values History Form online

1. Click the ‘Get Form’ button to access the Values History Form and open it in your preferred online editor.
2. Begin filling out the top portion of the form with your name and date. This personal information is vital for identification.
3. If someone assisted you in completing the form, please provide their name, address, and relationship to you in the designated fields. This information is helpful if someone else needs to refer to your preferences.
4. In Section 1, indicate whether you have previously expressed your wishes regarding medical treatment. Answer the provided questions, detailing any previous communications regarding specific medical procedures, such as organ donation or CPR.
5. If there are any medical procedures you have not yet addressed, provide your preferences directly in the boxes provided for each medical treatment option, including documentation location and any comments.
6. Move to Section 2 to reflect on your overall health, perceptions of your healthcare providers, and your thoughts about personal relationships, independence, and overall attitude toward life. Take your time to answer each question carefully.
7. Continue through Section 2, answering questions about your beliefs regarding illness, dying, and death as well as your religious background and living environment. These reflections will provide valuable context for your healthcare decisions.
8. After completing all sections, review your responses to ensure clarity and completeness. Feel free to add any comments that elaborate on your preferences.
9. Finally, save your completed Values History Form. You can download, print, or share it with your family, friends, and healthcare providers to make sure they are aware of your wishes.

Take the first step today by filling out your Values History Form online to ensure your healthcare values are understood.