Documents

Advance Care Planning Workbook

This workbook will walk you through the process of advance care planning. You will find conversation tools, a quality of life assessment worksheet, treatment wishes worksheet, and end-of-life plans that are very helpful tools to guide the conversation with your loved ones. Helping to define what is important to you based on your goals, your perspectives, and your values are extremely important parts of this conversation.

Download the Advanced Care Planning Workbook PDF.

Understanding Code Status

All patients admitted to a hospital or an outpatient facility (such as a dialysis center or outpatient surgery center) will be asked to choose a code status for the duration of their stay. Your chosen code status describes the type of resuscitation procedures, such as CPR, you would like the health care team to conduct if your heart stopped beating and/or you stopped breathing. Learn more about your code status options, definitions, and frequently asked questions from other patients.

Download the Understanding Code Status PDF.

Advance Medical Directive and Treatment Preferences

This is the legal document that will indicate your designated patient advocate(s) and your treatment preferences. Munson Healthcare switched from the Five Wishes booklet to the new Advance Medical Directive and Treatment Preferences booklet here. If you already have a Five Wishes booklet, completing this new one is your choice but not required. The Five Wishes booklet is still a legal advance directive and will be honored.

Download the Advance Medical Directive and Treatment Preferences PDF.

Do-Not-Resuscitate (DNR) Order

This document is an out-of-hospital DNR document. EMS personnel are required to perform CPR on all patients when 911 is called. If you do not want to have CPR performed, you must have this document available when 911 is called. You must print this from the link and take it to your physician because it requires your physician’s signature for it to be acted on. It is highly recommended that a DNR medical alert bracelet be worn. These can be purchased at most pharmacies when you present the signed physician DNR document. 

NOTE: If you have an out-of-hospital DNR document completed, this does not authorize a DNR order in the hospital setting. Because you can change your mind at any time, hospital personnel will ask you what your wishes are for CPR on each Emergency Department visit. If you have a DNR treatment preference written in your advance medical directive or medical durable power of attorney, this does not serve the same purpose and EMS personnel cannot act on an advance medical directive. 

Download the Do-Not-Resuscitate Order PDF.

Dementia Directive

Today, dementia affects many people. It can take several years to progress and cause numerous health and function issues, including the inabilities to communicate or make decisions. Planning ahead for the medical treatment you would prefer is important. This Dementia Directive is a specifically-designed communication tool that outlines the kind of medical care and quality of life you would want if you develop or have moderate or severe dementia. Because an advance directive or medical durable power of attorney document cannot always address the unique circumstances associated with the progression of dementia, we recommend using the Dementia Directive in conjunction with the Advance Medical Directive and Treatment Preferences. Doing this now, before dementia progresses, will help your loved ones and your healthcare team to provide the best care possible based on your values and goals for living a meaningful life. 

NOTE: A living will is not legally binding in Michigan and therefore should accompany the Advance Medical Directive and Treatment Preferences.

Visit the Dementia Directive website.

Questions? 

Contact our office at 231-935-6176 or svanslyke@mhc.net.