You have the right to express your wishes regarding the level and kinds of care you might wish to receive if you become unable to make these decisions for yourself. You may choose to express your wishes through advance directives such as a Durable Power of Attorney for Health Care, a Living Will or a Mental Health Treatment Declaration. These documents document your choices about your future care and, if you choose, name someone to decide for you if you should become unable to speak for yourself.
The following forms are available for download. You will need Adobe Acrobat Reader installed in order to read the downloaded file. If you would like additional information about Advanced Directives, please contact the Department of Pastoral Care at 217-788-3585 or the Clinical Ethics Center at 217-757-2353.
If you have a written advance directive, make sure your family and your physician are familiar with it. In addition, when you are admitted to this, or any other medical center or hospital, you should bring a copy with you at the time of registration so that it can be placed in your medical record.
Advance Directive Forms
Memorial's Advance Directives includes frequently asked questions, a Durable Power of Attorney for Health Care and a Living Will.
Memorial's Mental Health Treatment Declaration includes frequently asked questions.
Advance Directive Forms: English Spanish
Mental Health Treatment Declaration: English Spanish
Physician Orders for Life Sustaining Treatment (POLST): English Spanish
Illinois Department of Public Health Uniform Do-Not-Resuscitate (DNR) Advance Directive Order Form: English Spanish
DNR Instructions: English Spanish