Five Wishes Form

One of the best things you can do for your family upon your death is to leave a clear idea of who you want to make medical decisions for you if you become incapacitated, including: (who will be your Health Care Agent or Proxy–HCP); what kind and how much medical care you want at end of life; if life-support is or is not wanted; how pain is handled, where you would like to die, funeral wishes, etc. 5 Wishes Form There is a charge to use the Five Wishes Form which can be completed on line: Aging with Dignity website (which is not associated with AgeSure), but you can often get the paper form at your local Council on Aging office or through Alzheimer's Association or on Cape Cod through Hope Dementia & Alzheimer's Services serving Cape Cod and the Islands.

Although the Five Wishes Form is allowed in 42 states and the District of Columbia as a legal document, you should do a separate Do Not Resuscitate (DNR) form with your doctor. You may be required to have a DNR bracelet on to avoid resuscitation attempts. We also advise completing the Health Care Proxy (HCP) and Durable Power of Attorney (POA) forms through an Elder Law specialist attorney in the state where the patient resides.

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