What matters to you, matters to us.

To ensure we are honoring you and your family’s wishes for care, it is important for us to understand your wishes should you be unable to communicate your care plan to your doctor and care team. Being prepared will ensure your family and care team have the information they need from you to carry out your health care wishes.

Advance Directives Forms and Resources

Below are advance directive forms and resources to help you take the first step to prepare a care plan which helps provide guidance when you are unable to properly communicate your wishes. Please write your full name and birthdate on all the forms prior to sending to the Health Information Services department.

• Honoring Choices Pacific Northwest - Durable Power of Attorney for Health Care and Advance Care Planning — The Durable Power of Attorney for Health Care and Advance Care Planning form gives the person you designate the power to make the best health care decisions for you.
   
• Prepare for Your Care — This free, online program helps you through advance care planning. English and Spanish versions of the program are available.
   
• Conversation Starter Kit — The Conversation Starter Kit helps you ask, and answer, the important questions about what you really want for end-of-life care.
   
• POLST — If you are seriously ill or in very poor health, your health care provider can use the Portable Orders for Life-Sustaining Treatment (POLST) to represent your wishes for future care as clear and specific medical orders, indicating what types of life-sustaining treatment you want or do not want in the case of a medical emergency.
   
• End of Life — Death With Dignity Act Participation Policy
   
  
• Dementia Directive — Planning for the Future
   
  

What should you do with completed advance directive forms?

Please print these forms, complete them, and bring copies with you to your Virginia Mason clinic, or the Virginia Mason Hospital. You may also mail your completed DPOA, Directive to Physicians and POLST forms to:

Virginia Mason
Health Information Services, Mailstop: A-HIS-SCAN
1100 Ninth Ave.
Seattle, WA 98101

If you have questions about any of these advance directive forms or resources, or would like guidance completing the forms, don’t hesitate to discuss them with your doctor or someone from your care team. We can also provide you with printed material that will offer more information about advance directives.