Advance Instruction for Mental Health Treatment - North Carolina

Download Advance Instruction for Mental Health Treatment - North Carolina PDF

North Carolina · Fillable PDF · Free

A North Carolina advance instruction for mental health treatment states your wishes about medications, electroconvulsive treatment, and facility admission, to be followed if you later lack capacity to make mental health decisions. A North Carolina advance instruction for mental health treatment states your wishes about medications, electroconvulsive treatment, and facility admission, to be followed if you later lack capacity to make mental health decisions.

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Who this form is for

• A North Carolina advance instruction for mental health treatment states your wishes about medications, electroconvulsive treatment, and facility admission, to be followed if you later lack capacity to make mental health decisions.

What you'll need

• Read the packet and check the receiving agency's required form.
• Gather the names, dates and supporting records requested in the document.
• Review the packet's signing, identification and witness instructions.

How to complete it

1. Write your instructions (Pages 1–2) Describe your wishes. Be as specific as you can about medications and providers.
2. Sign with two witnesses and a notary (Page 3) North Carolina requires the advance instruction to be signed before two qualified witnesses and acknowledged before a notary. We can provide witnesses for an additional fee.
3. Give copies to your doctors, mental health providers, and health care agent.
4. You may combine it with a Health Care Power of Attorney (see Section 5.D of that form).

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