Overview of health care documents
Summary
Health care documents are a set of legal forms and papers that state a person’s wishes for medical care and treatment when they are seriously ill, in a medical emergency, or nearing the end of life. The documents give health providers and caregivers guidance, and also make it legal for doctors to withhold certain kinds of treatments. This article lists the main health care documents that an adult aging in place should create, and briefly explains each one.
What are health care documents?
Health care documents state what kind of care and treatment a person wants to receive when they are seriously ill, in a medical emergency, or nearing the end of life.
Health care documents not only give guidance to caregivers and providers, but also legally allow doctors and other medical professionals to follow the person’s wishes instead of state medical law. Creating a full set of health care documents is the best way for a person to end up receiving the treatment they want. They also take the guesswork out of many situations for caregivers.
The key health care documents are advance directives, Do Not Resuscitate and Do Not Intubate orders, HIPPA authorizations for medical records, living wills, medical powers of attorney, and portable medical orders (POLST).
Advance directives
Advance directives are a group of documents that say what kind of medical and health care treatment a person wants to receive at the end of life or in an emergency. Some common examples are the wish not to be kept alive artificially or moved to a hospital and a desire to have one’s organs donated.
Advance directives are legally binding, which means that the person’s health care providers can and must follow them. If these directives do not exist, doctors and other medical professionals need to follow their state’s medical laws when they make their decisions about the person’s treatments.
Different states and organizations include different documents when they use the term “advance directives.” For instance, some only mean a living will and medical power of attorney, while some include all of the documents listed in this article. No matter what they are called, though, all of the documents discussed here can be created in every state.
Do Not Resuscitate and Do Not Intubate orders
Do Not Resuscitate (DNR) and Do Not Intubate (DNI) orders are medical documents in which a person tells doctors and emergency medics not to try to bring them back to life using certain methods if their heart has stopped beating or they have stopped breathing.
A DNR order instructs doctors and medics not to perform cardiopulmonary resuscitation (CPR) on the person if their heart has stopped beating. A DNI order tells doctors and health-care workers not to put breathing tubes in if they are no longer breathing on their own. This includes both temporary ones and longer-term ones attached to a ventilator.
A person with a DNR and/or DNI order will still receive other kinds of efforts to revive them, unless they have given other instructions in an advance directive or to their medical power of attorney or proxy.
HIPAA authorization for medical records
HIPAA authorization for medical records is a form that an individual signs to allow their doctor or other health-related person or group to share their medical information with caregivers, family members, and others. Without this signed form, these medical professionals and agencies must follow the HIPAA Privacy Rule, which says that they have to keep almost all personal medical information private.
The individual can authorize the doctor (or other health care–related person or group) to share specific information, such as the results of a biopsy, or more general information, such as their overall medical status and treatment. They also can allow their medical information to be shared either with a specific person or with multiple people, including family members and friends.
Having a HIPAA release form signed by their loved one can be the only way for caregivers to receive relevant medical information from doctors and others. However, only the patient can make this decision, and they should never be pressured to do it.
Living wills
A living will is an advance directive that says what kind of medical care and treatment a person wants after they are no longer able to communicate their wishes directly. It can be written at any time, but it only takes effect when the individual is in the last stages of a life-ending illness and/or is permanently unconscious—for example, in a coma.
In their living will, a person can state their wishes about many aspects of what happens to them when they are unable to speak or make decisions. This includes whether they want to be given heavy painkillers, be put on a ventilator, receive blood transfusions, or be given CPR.
If there is a conflict between the instructions in a person’s living will and what they have told their medical power of attorney or proxy, health care professionals are legally required to follow the instructions in the living will.
Medical power of attorney
Medical power of attorney is a legal document giving an individual the power to make decisions about another person’s medical treatment. The person who receives this power is usually a spouse or family member, and they are called a medical proxy, health care proxy, or medical agent.
The proxy starts being able to make medical decisions when the person has stopped being able to make or communicate decisions for themselves.
Portable medical orders (POLST)
A portable medical order, also known as POLST, is a one-page medical form, filled out by a health professional, which says what kind of treatment a person wants doctors and medics to give them in a medical emergency. The order travels with the person from one setting to another—for example, from their home to a nursing home.
The POLST form allows the person to choose where they want to live while being given care (for instance, at home or at a hospital). It also lets them say what kinds of medical treatments they want, such as artificial feeding and antibiotics.
A POLST form is usually only recommended for frail or seriously ill people who are likely to have a medical emergency.
Related information
Advance directives
Do Not Resuscitate and Do Not Intubate orders
HIPAA authorization for medical records
Living wills
Medical power of attorney
Portable medical orders (POLST)
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