Get The Following Is An Example Of The Type Of Information You May ... - Humanservices Arkansas

Filling out the The Following Is An Example Of The Type Of Information You May ... - Humanservices Arkansas form is an important step in establishing your psychiatric advance directive. This guide provides clear and comprehensive instructions to help you complete the form effectively and confidently.

Follow the steps to fill out your advance directive accurately.

1. Click the ‘Get Form’ button to access the form and open it in the designated editor.
2. Begin with the statement of intent. Clearly write your name and specify that you authorize a health care agent to make decisions on your behalf when you are unable to do so.
3. Designate your mental health care agent by providing their name, address, and contact information. Ensure this person understands their role.
4. If applicable, designate an alternate mental health care agent by filling in their details to be contacted in case your primary agent is unavailable.
5. In the 'Authority Granted to My Agent' section, indicate if you wish to retain the right to change your agent, even during incapacity, by initialing the statement.
6. List your preferences for a court-appointed guardian if needed, along with their contact details.
7. Fill out the Facility Preferences sections, indicating your choices of treatment facilities and any preferences for where you wish to receive care.
8. In the Emergency Intervention section, specify what might trigger a mental health crisis and what actions staff can take to support you during such times.
9. Detail your preferences regarding medications and treatments, noting which medications you consent to and which you would like to avoid.
10. Complete the notification preferences section, specifying individuals who should be informed of your admission to a facility and anyone you wish to prohibit from visiting.
11. State your preferences for the care and temporary custody of your children, should you be unable to care for them.
12. Indicate your wishes about revocation of this directive and any other instructions relevant to your mental health care.
13. Finally, sign and date the document, ensuring that required witnesses also sign to validate your directive.
14. You can save changes, download, and print the filled-out form for your records or to share with others.

Complete your advance directive online today to ensure your mental health care preferences are respected.