U.S. Living Will Registry
The U.S. Living Will Registry is a nationwide service that stores your Advance Directive electronically and makes it available 24 hours a day to health care providers across the country. Your advance directive is made available to your family and doctors when most needed: when you're too sick to communicate your wishes. Through a partnership between Hospice Brazos Valley ~ Hospice Brenham, The College Station Medical Center, and St. Joseph Regional Health Center, this service is free for anyone in the community who would like to register. For more detailed information about this program, visit the U.S. Living Will Registry's website.
(Click here to access the registration form)
Advance Directives
Advance Directives are documents which allow an individual to determine in advance the types of treatment you want or do not want in case of specific and serious mental or physical illness. These documents communicate the individual's treatment desires to the physician and other medical personnel and become effective only when the individual becomes unable to make his/her desires known.
Federal laws require Hospice Brazos Valley ~ Hospice Brenham (HBV) to provide you information about Advance Directives. Patients of HBV are not required to use any of the Advance Directives as a condition to receive services from this organization.
Individuals who initiate any of the Advance Directives below may void them at any time. To void an Advance Directive, an individual may do so in writing or by verbally expressing his/her desire to do so. If you choose to use any of the Advance Directives, HBV will ask to have a copy for your chart and will send a copy to your physician. The original form will stay in the patient's home.
The individual executing the Advance Directive must sign it in front of two witnesses. These witnesses must not be related to the individual by blood or marriage, must not be anyone who will inherit any part of the designee's estate, and must not be a person providing health care to the individual executing the document. HBV staff, including volunteers, may not serve as witness for an Advance Directive form.
Directive to Physicians, Family, or Surrogate (Directive) (click here for form)
This document allows individuals to inform their physician which, if any, artificial methods he/she would/would not want to be used to attempt to extend life.
Procedure When a Person Has Not Executed a Directive and is Incompetent or Incapable of Communication (click here for form)
Family members and the individual's physician may execute this document and work together to plan for future health care when a patient is incompetent or incapable of communication. This form can take the place of a Directive to Physicians, Family, or Surrogate when one has not been executed by an individual.
Medical Power of Attorney (click here for form)
This document allows an individual to appoint another person(s) to make health care treatment decisions for the individual. This document becomes effective only if the individual becomes incompetent or incapable of communication and does not permit the designee(s) to make decisions to supercede the patient's decisions.
Out-of-Hospital Do-Not-Resuscitate (click here for form)
This document allows individuals to refuse resuscitation if that individual is outside of a hospital setting, such as in a private home or nursing care facility. This document empowers an individual to request that natural death be allowed. Execution of this document does not stop routine medical care. If the patient is incompetent or incapable of communication, two family members and the patient's physician may complete the form, determining that the patient would not want to be revived. For example: An individual died at home, and someone phoned 911. If the EMS personnel arrived at the home and were allowed into the home, they would have to attempt to revive the patient. The Out-of-Hospital Do-Not-Resuscitate directive would permit the EMS personnel to not attempt resuscitation.
Mental Health Declaration (click here for form)
This form allows the individual to determine what types of treatment he/she would or would not allow the physician to perform in attempts to cure the individual's mental illness.
