Mental Health Advance Directive - Pennsylvania

Pennsylvania · Fillable PDF · Free

This form lets you state your mental health treatment preferences in advance (the declaration) and name an agent to make mental health care decisions you have not covered (the power of attorney), in case a mental health crisis leaves you unable to decide. It lasts two years unless you are incapable when it would expire. you need to state your mental health treatment preferences in advance (the declaration) and name an agent to make mental health care decisions you have not covered (the power of attorney), in case a mental health crisis leaves you unable to decide.

Serving Pennsylvania. Appointments require a Pennsylvania-commissioned notary.

Download Mental Health Advance Directive - Pennsylvania PDF · 6 pages. No account required.

Book a notary for Mental Health Advance Directive - Pennsylvania

Who this form is for

This form lets you state your mental health treatment preferences in advance (the declaration) and name an agent to make mental health care decisions you have not covered (the power of attorney), in case a mental health crisis leaves you unable to decide. It lasts two years unless you are incapable when it would expire.

What you'll need

The original Mental Health Advance Directive - Pennsylvania packet and its instructions.
The names, dates and supporting records identified in this packet.
Acceptable identification if a notarial act is requested; arrange any required qualified witnesses.

How to complete it

Choose when it becomes effective (Part II-A) Usually when you are found incapable of making mental health decisions.
Mark your treatment preferences (Part II-B) Facility, medications, ECT, and research studies. Add anything that helps in a crisis.
Name your agent and alternate (Part III) Each agent signs to accept the appointment.
Limit your agent’s authority (Part III-D) Mark whether your agent may consent to medications, ECT and studies.
Sign before two adult witnesses and a notary Do not sign ahead of time. Bring a current photo ID.

Related Pennsylvania forms

Pennsylvania · Fillable PDF · 4 pages · Free

Health Care Power of Attorney - Pennsylvania

This form lets you name a health care agent to make medical decisions for you if you cannot make or communicate them yourself, and gives your agent access to your medical records. It does not cover money or property; for that, use a Durable General Power of Attorney.

View Health Care Power of Attorney - Pennsylvania · Download Health Care Power of Attorney - Pennsylvania

Pennsylvania · Fillable PDF · 3 pages · Free

HIPAA Authorization - Pennsylvania

This form lets doctors, hospitals and health plans share your medical information with family members or other people you choose. It does not let them make decisions for you; for that, use a Health Care Power of Attorney.

View HIPAA Authorization - Pennsylvania · Download HIPAA Authorization - Pennsylvania

Pennsylvania · Fillable PDF · 3 pages · Free

Living Will - Pennsylvania

A living will tells your doctors which life-sustaining treatments you do or do not want if you are terminally ill or permanently unconscious and cannot speak for yourself. It takes effect only when your attending physician receives it and determines that you are in one of those conditions.

View Living Will - Pennsylvania · Download Living Will - Pennsylvania

Pennsylvania · Fillable PDF · 3 pages · Free

Revocation of Advance Directive - Pennsylvania

Use this form to cancel all or part of a health care power of attorney, living will, or mental health advance directive. A written, notarized revocation leaves a clear record for hospitals and family.

View Revocation of Advance Directive - Pennsylvania · Download Revocation of Advance Directive - Pennsylvania

These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

Free legal forms by state · Book a mobile notary