What to include in your plan

Group 295

Essential Information

  • Record of your wishes
  • Temporary substitute decision makers list
  • Conversation starters
Group 295

Optional Documents

  • Representation agreement
  • Advance directive
  • Medical orders (No CPR Form & MOST)
Group 295

Things to Remember

  • Store, share, and review your plan
  • Wallet card
  • Printable checklist
Group 376

Essential Information to Include

Group 295

A record of what you thought and talked about – your values, beliefs, and wishes for health and personal care.

My Wishes, My Care: Thinking it Through

A step-by-step guide to help you think about and record what matters most to you – your values, beliefs and wishes for future health care and personal care. This guide can help you create a written or audio/video record of what matters most to you.

Group 296

A list of people who might be asked to make health-care decisions for you when needed.

Temporary Substitute Decision Maker Contact List

A template to help you record the contact information of your potential temporary substitute decision makers. You can include notes on who does not qualify and why.

To qualify, the person must:
• be 19 years of age or older,
• capable of making decisions,
• have no dispute with you, and
• have been in contact with you in the past year.

Conversation Starters

Conversations are key… in fact talking about your values, beliefs, and wishes for future care with the people you trust is the most important part of advance care planning (yes, even more important than making a plan!). Our conversation starters can help get the ball rolling.

Conversation starters available in four languages.

A worksheet of questions you can think, then talk about with your family and friends.

Group 374 (1)

Optional Documents You Can Include

A legal form you can make to appoint your own substitute decision maker.

What you need to know about standard representation agreements (section 7)

What you need to know about enhanced representation agreements (section 9)

Guide to the Enhanced Representation Agreement form (section 9) provided by the B.C. government.

A legal form you can make to record your health-care wishes for your health-care provider.

Talk to your doctor before making an advance directive!

2.2 1

The Government of B.C. provides a template in the advance care planning guide – My Voice (page 50).

Medical orders your health-care provider can make to record your wishes.

No CPR Form

A medical order signed by you and a doctor or nurse practitioner to refuse cardiopulmonary resuscitation (CPR).

MOST (Medical Orders for Scope of Treatment)

A medical order completed by a doctor or nurse practitioner to record what level care you wish to receive.

Remember!

Store your plan in a safe place where it can be easily located if needed (e.g. on your fridge).

Share your plan with the people you trust and your health-care providers.

Review your plan at regular intervals and when anything changes.

✓ Advance care planning isn’t a one-time event!

Wallet Card

A wallet card you can use to carry your advance care planning information with you.

Printable checklist with links to resources

This initiative is supported by funding from Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of Public Health Agency of Canada. Cette initiative bénéficie du soutien de l’Agence de la santé publique du Canada. Les opinions qui y sont exprimées ne représentent pas nécessairement les positions de l’Agence de la santé publique du Canada.

Scroll to Top