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[RED FLAG] Advance directive preparation worksheet

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Inspired Comforts Toolkit

Advance directives let you document your healthcare wishes in case you can’t speak for yourself. Heavy topic; not urgent for most patients but worth thinking through. Once filled in, use to complete your state’s official forms with a notary.

My healthcare proxy

Person I trust to make decisions for me
Their relationship to me
Phone and email
Backup proxy

My values and preferences

What ‘quality of life’ means to me
When I’d want aggressive intervention
When I’d prefer comfort-focused care

Specific preferences (if applicable)

  • I want CPR / I do not want CPR
  • I want mechanical ventilation / I do not
  • I want artificial nutrition / I do not
  • I want hospice when treatment is no longer working
  • I have organ donation preferences (yes / no / specific)
By the Inspired Comforts editorial team · inspiredcomforts.com

For inspiration only. Customize for your situation. Always consult your medical team. Inspired Comforts is not a medical provider.

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