Cottage Health System Advance Directives


Frequently Asked Questions

 

What is an Advance Directive?

An Advance Directive:

  • May be used to document the information about your wishes concerning important healthcare decisions.
  • Allows you to authorize another person to make healthcare decisions for you when you are no longer able to make decisions for yourself.
  • Allows you the choice to authorize another person to make healthcare decisions even when you are still capable of making your own decisions.

Download an Advance Directive form here or call Medical Social Services at 805-569-7495 to obtain a copy.

 

Advance Directive form
(English and Spanish) [PDF]

What are the required components of an Advance Directive?

An Advance Directive must contain:

  • The name of the individual you want to make healthcare decisions on your behalf
  • Your instructions related to the inclusion or exclusion of specific healthcare services.
  • The date and time the Advance Directive is initiated.
  • Signature of the individual whose healthcare decisions are directed by the document
  • Required declarations and signature of two witness who observed the signing of the document or acknowledgement of his/her signature and:
    • Is not listed as a decision maker on the Advance Directive
    • Do not provide healthcare services to the individual whose health care decision is directed by the Advance Directive
    • Are not employed by a healthcare provider that cares for the individual whose health care decision is directed by the Advance Directive
    • At least one of the two witnesses must be an individual who is not related by blood, marriage or adoption to the individual whose healthcare decisions are directed by the Advance Directive, and is not entitled to any portion of the estate of the individual whose healthcare decisions are directed by the Advance Directive.
    • In the absence of two qualified witnesses as noted above, the Advance Directive must be notarized to be valid.

If I have my Advance Directive in the Cottage Health System portal can anyone access it?

No, the portal is a secure system that meets the security requirements established by State and Federal Law. Only individuals that are part of the healthcare workforce are granted access to the Cottage Advance Directive portal. Once access is granted, a user identification and password is required to gain access.

  

How will my doctor know which Advance Directive is mine?

Each individual that requests their Advance Directive be placed on the Cottage Health System Advance Directive Portal completes a registration form. The information on the form is used to establish a unique record for the individual. The demographic information on the form is entered into our system and used to verify the individual. Your Advance Directive form is linked to the information provided on the registration form.

  

Do I have to complete all the information on the registration form?

The Social Security number and emergency contact information are preferred but optional. This information can be used to help ensure the provider is selecting the correct individual when there are data discrepancies due to data entry errors. The rest of the information is required to assist us in accurately identifying you and ensuring your Advance Directive is attached to your registration. The information is also used by your healthcare provider when searching for your Advance Directive. Name, date of birth, address, and phone number are demographic data that can be used to distinguish individuals with the same name or similar demographics, allowing the healthcare provider to ascertain the document being viewed is for the correct individual.

   

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