Get Short Form Virginia Advance Directive ... - Uva Health System

The SHORT FORM VIRGINIA ADVANCE DIRECTIVE is a crucial document that allows you to communicate your healthcare wishes in advance. This guide provides clear steps to help you fill out the form effectively, ensuring your preferences are understood and respected.

Follow the steps to complete your advance directive easily and confidently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your full name, date of birth, and hospital medical record number (if known) at the top of the form.
3. In Section 1, appoint your primary agent by providing their name, phone numbers, email, address, and relationship to you. If you wish to name a substitute agent, provide the same details for this person.
4. Review the instructions regarding your health care agent’s authority to make decisions based on your wishes. You may also add any specific instructions about visitation and additional powers if desired.
5. Proceed to Section 2 to provide any healthcare instructions you may have. Select one of the options presented by putting your initials in only one box that reflects your wishes concerning life-prolonging treatments.
6. If you have specific instructions regarding treatments you do or do not want, provide them in the space provided. Make sure these instructions do not conflict with your other directives.
7. In Section 3, indicate your decision regarding anatomical gifts if you wish to donate organs, tissues, or your body after death. Record your wishes clearly.
8. Once you have filled out all relevant sections, proceed to Section 4. Affirm your understanding and mental capacity by signing the document. Ensure you date the form.
9. Include signatures from two adult witnesses who can attest they saw you sign the directive.
10. If necessary, provide an interpreter attestation signature if any interpretation was required during the process.
11. Review the completed document to ensure all information is accurate. Save changes, and you can download, print, or share the form as needed.

Complete your advance directive online today to ensure your healthcare wishes are respected.