Advance care planning patient paperwork

Advance care planning (ACP) is a process for you to reflect on your goals, values and make plans about your current and future health choices. The information below will help you understand different types of ACP forms and how to complete them.

To get started, we suggest that you use our What to Expect: Advance Care Planning document, along with our introduction letter and checklist, as guides for completion of these documents.

Durable Power of Attorney for Health Care (DPOAH)

A DPOAH is a legal document that allows an individual to declare who may speak for them when they cannot speak for themselves. This individual is called a patient advocate.

Treatment preferences

It is helpful to your patient advocate if you also complete a treatment preference form. This is a document that captures what’s most important to you and allows you to express any specific treatment preferences you may have, such as CPR or ventilator support.

Submitting completed forms

Once you have completed your form(s), you may return them to us in any of the following ways:

  • Bring the forms to any Spectrum Health location
  • Email completed forms to advancecareplanning@spectrumhealth.org
  • Fax completed forms to 616.391.8965
  • Mail completed forms
    • Spectrum Health Advance Care Planning
      100 Michigan Street NE | MC 041
      Grand Rapids, MI 49503

Have Questions?

We’re here to help. If you have any questions or need help completing these forms, please email or call us.