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Home
About
The ACP and Healthy Living Through Faith Program
The African-American ACP/PC Network
Affiliated Institutions of Network Members
Events
Resources
Advance Directives Forms
Books
Pamphlets
Videos
Websites
Resources for Academics and Clinicians
Resources for Clergy and Churches
Resources for Families and Decision-Makers
Contact Us
Advance Directives Forms
Advance Directive Forms
Learn about the most common forms in advance care planning
(Forms and guidelines are for the State of North Carolina, unless stated otherwise)
And, always remember to...
Share your end-of-life wishes with:
— Your Family
— Your Medical Provider
— Your Medical Decision-Maker
For assistance with Forms:
Key Terms
Pamphlets
Videos
Body Donation
Anatomical Donation to Science
Obtain online.
Must be signed by two witnesses after consenter.
Consider creating a lasting legacy by advancing medical research and education.
DNR Form
Do Not Resuscitate
Obtain from and complete with a physician.
Must be signed by a physician.
Share your wishes about receiving CPR, if your heart or breathing stops.
Durable POA
Durable Power of Attorney
Obtain online or through attorney.
Must be notarized after consenter signs.
Written authorization for one to act on your behalf regarding assets, private affairs, and legal matters.
HCPOA
Health Care Power of Attorney
Obtain online.
Must be signed by two witnesses after consenter.
Name a person to make health care decisions for you, if you are unable.
English
Spanish
Living Will
Health Care Directive
Obtain online.
Must be signed by two witnesses after consenter.
Clarify medical wishes and special circumstances when you want to receive life-sustaining treatment.
English
Spanish
MOST Form
Medical Orders for Scope of Treatment
Obtain from and complete with a physician.
Must be signed by a physician.
Directly communicate your values and wishes for care with a physician.
Organ Donation
Anatomical Donation to Science
Obtain online or at Department of Motor Vehicles.
Register online or at Department of Motor Vehicles.
Consider donating your organs or tissues to someone in need, after you die.
General Information
North Carolina Information
POLST Form
Physicians Order for Life Sustaining Treatment
Obtain from any medical professional.
Can be signed by any medical professional.
Only available once a person reaches an advanced, progressive, or terminal stage of illness.
Will
Last Will and Testament
Obtain online on through attorney.
Only requires your signature.
Choose how, and to whom, you want your estate distributed, after you die.