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Advance Directive forms are available from the Nursing Staff. Full cardiopulmonary resuscitation shall occur on all patients in the Surgicenter. If you wish another level of care, discuss this with your surgeon or anesthesiologist prior to your procedure.

There are three parts to the North Dakota Advance Healthcare Directive. This is a legal document and allows you to do one or all of the following:

Part I: Name another person to make healthcare decisions for you if you are unable to make and communicate healthcare decisions for yourself. The person you designate to act as your representative is called your AGENT and must act in your best interests.

Part II: Give healthcare instructions. These are instructions for your healthcare when you are unable to make and communicate healthcare decisions for yourself. These instructions permit you to decide whether you want life-prolonging treatment, nutrition, or hydration.

Part III: Making an anatomical gift. This allows you to indicate your wishes to donate any needed organs and tissues, or only those specified in the healthcare directive.

A healthcare directive becomes effective when:

1. You have executed a healthcare directive;
2. Your agent has accepted the position in writing; and
3. Your doctor has certified in writing, that you "lack the capacity to make healthcare

To be legal in North Dakota, a healthcare directive must:

1. Be in writing.
2. Be dated and signed by the person to whom it applies or by another person authorized to sign on behalf of the person to whom it applies.
3. Be executed by a person with the capacity to understand, make and communicate decisions.
4. Contain verification of the required signature, either by a notary public or by qualified witnesses.
5. Include a healthcare instruction or a power of attorney for healthcare, or both.

You cannot be required to complete an Advance Healthcare Directive. Your decision to do so is personal and should be based upon your individual values and beliefs.

To complete an Advance Healthcare Directive:

1. Use the appropriate form. Forms are available from the Nursing Staff.
2. Carefully select the person you want to act as your agent and/or alternate agent. Discuss the role of your agent and/or alternate agent with the person(s) you select and obtain their consent.
3. Tell your agent what kind of healthcare decisions you want your agent to make on your behalf. You should also consider any written instructions you might wish to include to limit the agent's authority or to provide guidance for your agent.
4. Sign your Advance Healthcare Directive in front of a notary public or two appropriate witnesses as required under state law. There are restrictions as to who may legally witness this document.
5. Your agent and alternate agent(s), if you have them, must sign your Advance Healthcare Directive indicating they accept appointment and are willing to serve.
6. After signing an Advance Healthcare Directive, distribute copies of the document. You may choose to give the original to your agent or put in a place where it is accessible to your agent or alternate agent. It is recommended you provide copies to your physician, hospital nursing home, other health care providers, and family members.


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