Need help?

We're here to answer your questions.

What's an advance directive?

Who is this for?

box-icon-form-v2

If you’re a Medicare member, you can use this form to list your decisions on medical care, if a time comes when you can't make them for yourself.

You may not want to think about it, but there could come a time when you won’t be able to make important decisions.

Having an advance directive on file may make it easier for you and your family. This legal document lists your medical choices for your doctors to follow, if someday you lose the ability to make them for yourself.

It also lets you pick someone you know and trust to make decisions for you if you can’t.

How to file an advance directive:

  • Talk to your doctor about the important treatment decisions you might have to make in the future.
  • Fill out this Patient Advance Directive form (PDF) in front of a witness. You can also write additional instructions on a piece of paper and attach those to the form.
  • Choose someone you know and trust to make health care decisions in your place.
  • Discuss your treatment choices with this person. Have him or her accept the role in this Patient Advocate Acceptance form (PDF).
  • Name your advocate in a Durable Power of Attorney form (PDF). You’ll need two witnesses for this document.
  • Then give a copy of your advance directive to those who might need it: your doctor, spouse, advocate, lawyer or friend.

Was this content helpful?

Rate it

Submit >

©1996-2014 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. State and Federal Privacy laws prohibit unauthorized access to Member's private information. Individuals attempting unauthorized access will be prosecuted.

Site Map  |  Feedback  |  Important Legal and Privacy Information  |  Important Information About Medicare Plans

Y0074_W_Jul14WebBCBSBCN CMS Approved 08292014

Page Last Updated Tue Jul 08 15:53:50 EDT 2014