FORMS & EXPLANATIONS FROM GOVERNMENTAL AGENCIES & DEPARTMENTS:

• PA Department of Aging:

  • Advanced Directive/Living Will form & info (2005 Version):
    

    • Note: These web pages were posted by the PA DOA previously under the prior version of Chapter 54, not under Act 169's new version, and therefore are somewhat outdated.
      "Advance Directive for Health Care (Living Will)" - Online explanation (Rev. 04/13/05)
      "Understanding Advance Directives for Health Care: Living Wills & Powers of Attorney in Pennsylvania" (Pamphlet in PDF format, 6 pages, 2005)

  • Advanced Directive/Living Will form & info (2007 Version):

    • Description: The Pennsylvania Department of Aging explains what the advance directive for health is, shows what the benefits are, and who is eligible. (Posted January 17, 2007).
      

• PA Department of Health:

  • Advance Care Directives:

• Senate Bill 628, amends Title 18 (Crimes & Offenses) and Title 20 (Decedents) related to health care power of attorney, living wills and out-of-hospital do-not-resuscitate orders. The bill re-writes and replaces Chapter 54 of Title 20 to provide a statutory means for competent adults to control their health care through written instructions or by health care agents or representatives and requested orders, for execution and revocation of living wills, for health care power of attorney and for the appointment and revocation of health care agents and selection and duties (Posted January 27, 2007).
• The following PDF or Word document is an example of a document that combines a living will and health care power of attorney:

• Sample Forms for Advance Directives (PDF)
• Sample Forms for Advance Directives (DOC)

• Out-of-Hospital Do-Not-Resuscitate (DNR) Orders -- "A Guide for Patients & Families"

  Additional Information & Forms:
  • DNR Order - Questions and Answers
  • DNR Supply Order Form (Health Care Providers Only)
  • Sample Out-Of-Hospital DNR Order (Prior versions of this form remain valid and are to be honored)
  • DNR Regulations from the Pennsylvania Code
  • DNR Act from Westlaw
  • Picture of DNR Bracelet & Necklace
  • Prehospital DNR Training Program