Advance Directives - Living Will

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On January 11, 1992, a New Jersey law took effect which mandates that all health care facilities ask Patients whether they have an Advance Directive or Living Will. At Florham Park Surgery Center we have made this part of the admitting process.

If you have an Advance Directive or Living Will, please bring a copy of it with you to the center on the day of your procedure. While you are a patient at Florham Park Surgery Center, your Advanced Directive will not be honored. Should you be transferred to a hospital, a copy of your Advanced Directive will be sent with you.

An Advance Directive or Living Will is used by an individual to indicate their voluntary, informed voice of accepting, rejecting, or choosing among alternative courses of medical treatment.

An Advance Directive or Living Will is a document which allows you to give written instruction to those caring for you indicating the type of health care you would wish to receive or reject in the event you become unable to express these decisions yourself.

There are three different types of Advance Directives:

• A Proxy Directive

  This is a document in which a competent adult names a trusted relative or friend to make health care decisions on their behalf when they are unable to make these decisions.

• An Instruction Directive

  In this document, the person writing it provides written instructions concerning the type of medical treatment they want or do not want performed for them and under what circumstances.

• A Combined Directive

  In this document, a competent adult stated their general wishes regarding the kind of health care they wish to receive but appoints a trusted relative or friend to carry them out.

A brochure containing living will information is available from the Division of Aging.
If you wish to receive the brochure, please make your request to:

The Division of Aging

101 South Broad Street

CN 807

Trenton, NJ 08625

For more information contact:

State of New Jersey’s Department of Health and Senior Services
State of New Jersey’s Department of Health and Senior Services
P.O. Box 360, Trenton, NJ 08625-0360
Phone: (609) 292-7837
www.state.nj.us/health/advancedirective/

Do you have an ADVANCED DIRECTIVE or LIVING WILL? Yes or No
If yes, please send it or bring it to the center prior to your scheduled procedure.

Prior to your appointment you will be required to sign a sheet with the above information indicating you are aware of the above information.