Advance Directives

Advance Directives

Power of Attorney for Health Care
Client's Name*

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Nebraska’s Health Care and Treatment Decisions statute allows you to appoint an agent (called an “Attorney in fact”) to make health care decisions for you if you become incompetent to make those decisions yourself. “Health care” may include mental health care. A recommended form for this purpose is called a Power of Attorney for Health Care.

An Advance Directive or Power of Attorney for Healthcare is a legal document that talks about how you want to be treated if you are not able to speak for yourself, for example, if you become very ill, or if you are put in a hospital without your permission. You can use an Advance Directive – Power of Attorney for Health Care to:
• Tell a doctor, hospital or judge what types of confinement and treatment you do or do not want.
• Name a friend or family member who can make mental health care decisions for you if you are not able to make them for yourself.

Additional information is available from the National Resource Center on Psychiatric Advance Directives: http://www.nrc-pad.org.

Once your Power of Attorney for Health care form is ready, you should give copies and explain your choices to:
• Your Doctor
• The person you have appointed to make mental health care decisions for you.
• Your family
• Anyone else who might be involved in your care
Please Check One of the Following:

I have an Advance Directive – Power of Attorney and will discuss its contents with my provider.I DO NOT have an Advance Directive – Power of Attorney, but understand how to put one in place based on the above information.
Signature (Legal Guardian Signature if Client is a minor)

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