Honoring Choices Mn PDF 2014

C. Review and release my medical records and personal files as needed for my health care as stated in the Health Insurance Portability and Accountability Act of 1996 HIPAA and the Minnesota Health Records Act. To stop or withhold all treatments that extend my life. This includes but is not limited to tube feedings IV intravenous fluids respirator/ventilator breathing machine cardiopulmonary resuscitation CPR and antibiotics. Your Care Agent. If you have any questions or concerns please contact an Essentia Health St. Joseph s Medical Center Chaplain in Brainerd Minnesota at 218-828-7530. I understand that recovery from CPR can be painful and difficult. Therefore I want CPR attempted if my heart or breathing stops. NOTE This document does not apply to intrusive mental health treatments defined as electroconvulsive therapy or neuroleptic medications. Cardiopulmonary Resuscitation A Decision for the Present This decision refers to a treatment choice I am making today based on my current health. This document gives my treatment choices and preferences and/or appoints a Health Care Agent to speak for me if I cannot communicate or make my own health care decisions. E. Decide which health care providers and organizations provide my health care. in Part 2 of this document. Health Care Directive English Introduction I have completed this Health Care Directive with much thought. My Health Care Agent if named is able to make medical decisions for me including the decision to refuse treatments that I do not want. Any advance directive document created before this is no longer legal or valid* My name My date of birth My address My telephone numbers home cell My initials here indicate a professional medical interpreter helped me complete this document. Part 1 My Health Care Agent If I cannot communicate my wishes and health care decisions due to illness or injury or if my health care team determines that I cannot make my own health care decisions I choose the following person to communicate my wishes and make my health care decisions. My Health Care Agent must Follow my health care instructions in this document. Follow any other health care instructions I have given to him or her. Make decisions in my best interest. My Primary main Health Care Agent is Name Relationship Telephone numbers H C W Full address If I cancel my primary agent s authority or if my primary agent is not willing able or reasonably available to make health care decisions for me I choose an alternate Health Care Agent. My Alternate Health Care Agent is This is the directive of name Date Completed I understand my Health Care Agent primary or alternate cannot be a health care provider or employee of a health care provider giving me direct care to me unless I Am related to that person by blood or marriage registered domestic partnership or adoption Provide a clear reason why I want that person to serve as my agent Powers of my Health Care Agent My Health Care Agent automatically has all the following powers when I am unable to communicate for myself A.