Advance Health Care Directive

If you would like to print the form at home you can get a copy here: [Advance Health Care Directive]

If you would like to obtain one at the hospital they can be found in Admissions, the Business Office and Medical Records.

Glossary of Terms:

Advance Health Care Directive: A general term describing two kinds of legal documents, an individual's instruction and a power of attorney for health care. These documents allow a person to give instructions about future medical care in case they are unable to participate in medical decisions due to serious illness or incapacity.

Agent: A person designated in a power of attorney for health care to make health care decisions for the person granting the power.

Artificial Nutrition and Hydration: Supplying food and water through a conduit, such as a tube or an intravenous line where the recipient is not required to chew or swallow voluntarily, including but not limited to nasogastric tubes, gastrostomies, jejunostomies and intravenous infusions. Artificial nutrition and hydration does not include assisted feeding, such as a spoon or bottle feeding.

Capacity: An individual's ability to understand the significant benefits, risks and alternatives to proposed health care and to make and communicate a health care decision.

Health Care: Any care, treatment, service or procedure to maintain, diagnose or otherwise affect an individual's physical or mental condition.

Health Care Decision: A decision made by an individual or the individual's agent, guardian, or surrogate, regarding the individual's health care, which may include: selection and discharge of health care providers and institutions; approval or denial of diagnostic tests, surgical procedures, programs of medication and orders not to resuscitate; and directions to provide, withhold or withdraw artificial nutrition and hydration and all other forms of health care.

Health Care Institution: An institution, facility or agency licensed, certified or otherwise authorized or permitted by law to provide health care in the ordinary course of business.

Hospice: An institution or service that provides palliative care when medical treatment is no longer expected to cure the disease or prolong life.

Individual Instruction: An individual's wishes concerning a health care decision for the individual.

Notary Public: A person who administers oaths, certifies documents, takes affidavits, and attests to the authenticity of signatures.

Physician: An individual authorized to practice medicine under the Wyoming Medical Practice Act.

Principal: The person who gives authority to an agent to make health care decisions in the event that he or she becomes incapacitated. Also, the person for whom the advance health care directive has been created.

Power of Attorney for Health Care: The designation of an agent to make health care decisions for the individual granting the power. This type of advance directive might also be called a health care proxy, or durable power of attorney for health care.

Health Care Provider: Any person licensed under the Wyoming statutes practicing within the scope of that license is a licensed physician, licensed physician's assistant or licensed advanced practice registered nurse.

Primary Physician: A physician designated by an individual or the individual's agent, guardian or surrogate to have primary responsibility for the individual's health care or, in the absence of a designation, or if the designated physician is not reasonably available, a physician who undertakes the responsibility.
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