Name: Personal Directives
SKU: 16321
Availability: InStock

1 Get Started

2 Decision Maker

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6 Treatment Preferences

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13 Miscellaneous

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19 Signing Details

20 Final review

Step 1 of 20 - Get Started

Details Info
MD Legals has its own corporate lawyer who will prepare the Personal Directives. We have made it very simple and easy. All you need to do is, filling out this step by step form, pay and submit. Our specialist will review your submitted information, will contact you if anything is missing
Location
1.1 Please Select your prince:
Built for Alberta
Different provinces have different rules and regulations. Your Personal Directives will be customized for Alberta
Built for British Columbia
Different provinces have different rules and regulations. Your Personal Directives will be customized for British Columbia.
Built for Manitoba
Different provinces have different rules and regulations. Your Personal Directives will be customized for Manitoba
Built for New Brunswick
Different provinces have different rules and regulations. Your Personal Directives will be customized for New Brunswick.
Built for Newfoundland and Labrador
Different provinces have different rules and regulations. Your Personal Directives will be customized for Newfoundland and Labrador.
Built for the Northwest Territories
Different provinces/territories have different rules and regulations. Your Personal Directives will be customized for the Northwest Territories.
Built for Nova Scotia
Different provinces have different rules and regulations. Your Personal Directives will be customized for Nova Scotia.
Built for Nunavut
Different provinces/territories have different rules and regulations. Your Personal Directives will be customized for Nunavut.
Built for Ontario
Different provinces have different rules and regulations. Your Personal Directives will be customized for Ontario.
Built for Prince Edward Island
Different provinces have different rules and regulations. Your Personal Directives will be customized for Prince Edward Island.
Built for Quebec
Different provinces have different rules and regulations. Your Personal Directives will be customized for Quebec.
Built for Saskatchewan
Different provinces have different rules and regulations. Your Personal Directives will be customized for Saskatchewan.
Built for the Yukon Territory
Different provinces/territories have different rules and regulations. Your Personal Directives will be customized for the Yukon Territory.
List your health care instructions and Name someone to make health care decisions for you
Full Name
Phone
Email
Personal Health (Care Card) Number:
Date of Birth:
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Guidelines
Condition of personal directive?
Any person who is at least 18 years of age and understands the nature and effect of a personal directive may make a personal directive. In addition, you must be:
- mentally competent
- informed of your treatment options for all possible medical outcomes
- free of undue influence by anyone else during your decision making process

Decision Maker
2.1 Do you want to name someone to make your personal decisions if you're unable to?

Guidelines
Do I have to name a decision maker?
- In Alberta you do not have to name a decision maker. However, if possible you should name someone to ensure your wishes are followed.
- It's also important you discuss your wishes with the person you name so they are prepared for the responsibility. In particular, you should discuss anything you haven't addressed in this Personal Directive.
Personal decisions?
Personal decisions typically include all decisions relating to health care, accommodation, participation in social activities, the people with whom you may live and associate, where you may work, educational activities, and authority over legal matters.

Your Decision Maker
Who do you want to name as your decision maker?
Full Name
Phone
Email
Date of Birth:
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
3.1 Do you want to add another decision maker
Second Decision Maker
Full Name
Phone
Email
Date of Birth:
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
3.2 Do you want to add another decision maker
Third Decision Maker
Full Name
Phone
Email
Date
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
3.3 Do you want to add another decision maker
Fourth Decision Maker
Full Name
Phone
Email
Date
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
3.4 Do you want to add another decision maker
Fifth Decision Maker
Full Name
Phone
Email
Date of Birth:
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Guidelines
What is a decision maker also called?
A decision maker is also called an Agent in Alberta.
What happens if I designate more than one person as my decision maker?
- If you name more than one person as your decision maker, select people who can cooperate and be decisive.
- If the people you're thinking of choosing have a history of conflict, it may be better to only name one person.
decision maker?
An agent must be 18 years of age or older and have the capacity to make personal decisions on behalf of the Maker.
Does the order of my decision makers matter?
Yes, it can. In the next step, you will choose if your Agents make decisions jointly or successively. If you choose successively, the first person you name will be your decision maker. The second person will only have authority if your first decision maker is unable or unwilling to act.

Decision Making Method
4.1 Do you want your decision makers to work together to make decisions?
Where your Agents are acting jointly they will make decisions using:

Guidelines
Do you want your decision makers to work together to make decisions?
Jointly means the decision makers will work together and make decisions through unanimous or majority agreement.
Successively means the first named decision maker will have authority to make decisions. If that decision maker is unable or unwilling to act, authority will pass to the next decision maker you named.

Duties and Authority
5.1 How much authority will your decision maker have?
Describe the specific areas of authority that you wish to give to your decision maker:
Agent #1
e.g. healthcare, accommodation, participation in social activities, the people with whom I may live and associate, where I may work, educational activities, authority over legal matters.
Agent #2
e.g. healthcare, accommodation, participation in social activities, the people with whom I may live and associate, where I may work, educational activities, authority over legal matters.
Agent #3
e.g. healthcare, accommodation, participation in social activities, the people with whom I may live and associate, where I may work, educational activities, authority over legal matters.
Agent #4
e.g. healthcare, accommodation, participation in social activities, the people with whom I may live and associate, where I may work, educational activities, authority over legal matters.
Agent #5
e.g. healthcare, accommodation, participation in social activities, the people with whom I may live and associate, where I may work, educational activities, authority over legal matters.

Guidelines
how much your decision maker will have authority?
Your decision maker will have authority to make personal decisions on your behalf. Personal decisions typically include all decisions relating to healthcare, accommodation, participation in social activities, the people you live and associate with, where you work, educational activities, and authority over legal matters.

Healthcare Instructions
What health care treatments do you consent to?
e.g. I consent to life-sustaining treatment and artificial hydration and nutrition to prolong my life even if it will cause me pain and discomfort.
What health care treatments do you refuse to consent to?
e.g. I am bound by my religious beliefs to refuse the following treatments or types of treatments: blood transfusion, organ transplant, other.

Terminal Condition
If your condition is determined to be terminal and with no hope of recovery, what do you want done?
6.1 Life Support
Type your instructions or wishes.
6.2 Tube Feeding
Type your instructions or wishes.
6.3 CPR
Type your instructions or wishes.
6.4 Intervening Illness
Type your instructions or wishes.

Guidelines
Life support ?
Life support means any medical procedure, treatment, or intervention, which sustains, restores, or replaces a spontaneous vital function.
Tube feeding?
Tube feeding means the provision of nutrients or fluids by a tube inserted in vein, under the skin in the subcutaneous tissues, or in the stomach.
CPR?
CPR — cardiopulmonary resuscitation — is the restoration of heartbeat and breathing following cardiac arrest, using artificial respiration and external cardiac massage.
Intervening Illness
An intervening illness is a separate illness (e.g. pneumonia) that may be life threatening.

Persistent Unconsciousness
If you are persistently unconscious with no hope of recovery, what do you want done?
7.1 Life Support
Type your instructions or wishes.
7.2 Tube Feeding
Type your instructions or wishes.
7.3 CPR
Type your instructions or wishes.
7.4 Intervening Illness
Type your instructions or wishes.

Guidelines
How is this different from terminal condition?
- A terminal condition is one that will result in death, but you are aware of your surroundings.
- Persistent unconsciousness means you are not aware of your surroundings.
Life support?
Life support means any medical procedure, treatment, or intervention, which sustains, restores, or replaces a spontaneous vital function.
Tube feeding?
Tube feeding means the provision of nutrients or fluids by a tube inserted in vein, under the skin in the subcutaneous tissues, or in the stomach.
CPR
CPR — cardiopulmonary resuscitation — is the restoration of heartbeat and breathing following cardiac arrest, using artificial respiration and external cardiac massage.
Intervening Illness
An intervening illness is a separate illness (e.g. pneumonia) that may be life threatening.

Severe and Permanent Mental Impairment
If you are severely and permanently mentally impaired, what do you want done?
8.1 Life Support
Type your instructions or wishes.
8.2 Tube Feeding
Type your instructions or wishes.
8.3 CPR
Type your instructions or wishes.
8.4 Intervening Illness
Type your instructions or wishes.

Guidelines
If you are severely and permanently mentally impaired, what do you want done?
Severe and permanent mental impairment means a permanent and irreversible condition in which there is:
- 1. The absence of voluntary action or cognitive behavior of any kind.
- 2. An inability to communicate or interact purposefully with the environment.
If you were suffering from severe and permanent mental impairment you would not be aware of what was happening to you or around you.
Life support
Life support means any medical procedure, treatment, or intervention, which sustains, restores, or replaces a spontaneous vital function.
Tube feeding
Tube feeding means the provision of nutrients or fluids by a tube inserted in vein, under the skin in the subcutaneous tissues, or in the stomach.
CPR
CPR — cardiopulmonary resuscitation — is the restoration of heartbeat and breathing following cardiac arrest, using artificial respiration and external cardiac massage.
Intervening Illness
An Intervening Illness is a separate illness (e.g. pneumonia) that may be life threatening.

Other Treatments
9.1 Do you have strong feelings about certain kinds of treatment you wish to express in your Personal Directive?
Indicate your consent or refusal to each of the following treatments
Antibiotics:
Blood Transfusion:
Chemotherapy:
Defibrillation:
Intravenous (IV) Therapy:
Intubation:
Kidney Dialysis:
Radiation:
Surgery:
Do you have strong feelings about other treatments that you wish to express in your Personal Directive?
Give additional instructions about any potential treatment that concerns you:
e.g. My religious beliefs strictly prohibit any medical treatment that involves the transfusion of whole blood or the transfusion of constituent blood products including red cells, white cells, platelets or plasma even in the case of a medical emergency.

Guidelines
What treatment preferences CANNOT be requested?
Remember:
- You cannot refuse drugs intended for pain relief.
- You cannot refuse nourishment by mouth.
- Finally, you cannot request treatment that your medical team thinks is inappropriate.
Defibrillation?
Defibrillation is heart stimulation with electric current
Intubation?
The insertion of a tube to aid in breathing.

Comfort and Dignity
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- Include the following statement in my Living Will regarding behavior controlling drugs:
If I am suffering from one of the above-mentioned conditions and if my behaviour becomes violent or is otherwise degrading, I want my symptoms to be controlled with appropriate drugs, even if that would worsen my physical condition or shorten my life.
Untitled
- Include the following statement in my Living Will regarding pain controlling drugs:
If I am suffering from one of the above mentioned conditions and I appear to be in pain, I want my symptoms to be controlled with appropriate drugs, even if that would worsen my physical condition or shorten my life.
Organ Donation
10.1 Would you like to provide directions about organ donation?
10.1 Organ donation?
Type your wishes, instructions or beliefs.
e.g. It is my wish that my heart and lungs be used for transplantation upon my death. I do not want my eyes to be used for transplantation upon my death.

Guidelines
This wording is in relation to what?
This wording is in relation to terminal conditions, persistent unconsciousness, or severe and permanent mental impairment.
Directions about organ donation?
Most provinces require registration with the provincial donor registry. It's still a good idea to record your preferences in your Living Will. It's also extremely important to discuss your decision with your family to ensure your wishes are fulfilled.

Statement of Values and Beliefs
11.1 Would you like to include a statement of values and beliefs?
What values and beliefs would you like considered if health care decisions are being made for you?
e.g. My fundamental belief is that a person should be allowed to die with grace and dignity and that a life should not be prolonged with aggressive medical treatment where the resulting quality of life is poor and where there is no reasonable expectation of recovery.
More Examples
- For more examples
Example #1: I prefer to be treated at home where I may be closer to my family and friends.
Example #2: In the event that I no longer have capacity to refuse or consent to health care on my own behalf it is my intent that this Personal Directive be respected by my physicians, my family and friends, as well as any other caregivers.
Example #3: I am bound by my religious beliefs to refuse the following treatments or types of treatments:
Blood Transfusion

Organ Transplant

Other

Guidelines
Include a statement of values and beliefs?
While this statement is not binding on medical professionals, it could provide them with the kind of information they need to make decisions for you when you are no longer able to do so for yourself. This feature is optional.

Specific Instructions
12.1 Do you wish to provide specific instructions or guidance for your decision maker?
Specific instructions for my decision maker:
12.2 Do you wish to provide specific instructions for your service provider?
Where your decision maker cannot be found or is unable or unwilling to make personal decisions for you, you may wish to leave specific instructions for your service provider.
Specific instructions for my service provider:

Guidelines
Instructions or Guidance for your decision maker?
Remember:
- You cannot refuse drugs intended for pain relief.
- You cannot refuse nourishment by mouth.
- Finally, you cannot request treatment that your medical team thinks is inappropriate.

Determination of Incapacity
13.1 Do you wish to designate the individuals who will determine your incapacity?
You may designate one or more persons who, in consultation with a physician or psychologist, will make a written declaration that you lack capacity. If you decide not to designate anyone now then a determination of incapacity may be made later by two service providers responsible for your care where at least one service provider is a physician or a psychologist.
Primary Individual
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
13.2 Do you want to add another individual
Second Individual
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
13.3 Do you want to add another individual
Third Individual
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Guidelines
Name of Individual?
A person making a determination of incapacity does not have to be a physician. However the person or persons you select must consult with a physician or psychologist, and provide a written declaration that the Maker lacks capacity.

Confidential Information
14.1 Do you want to provide instructions about access to your confidential information?
Instructions with respect to access to confidential information:
Care of Minors
14.2 Do you want to name someone to provide temporary care and education of minor children?
Primary Agent
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
14.3 Do you want to add another Agent
Second Agent
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
14.4 Do you want to add another Agent
Third Agent
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Revoke Previous Directives
15.1 Do you wish to revoke any previous directive made by you?
Revocation of Current Directive
15.2 When would you like this Personal Directive revoked?
Enter a specific date when this Personal Directive will be revoked:
Date Format: MM slash DD slash YYYY
Enter the event or conditions under which this Personal Directive will be revoked:
e.g. As soon as I regain capacity after heart surgery.

Guidelines
revoke any previous directive
- You should revoke your previous directive if the authority you granted in it overlaps with the authority you are granting in this directive. If you do not revoke the previous directive, it may not be clear what the duties of each decision maker are.
- If you want a previous directive to continue it should deal with different matters than this directive.

Notification of Incapacity
16.1 Do you wish to list anyone, other than your decision maker, who needs to be notified in case you become incapacitated?
Primary Person to Notify
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
16.2 Do you want to add another person to notify
Second Person to Notify
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
16.3 Do you want to add another person to notify
Third Person to Notify
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
16.4 Do you want to add another person to notify
Fourth Person to Notify
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
16.5 Do you want to add another person to notify
Fifth Person to Notify
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Guidelines
Who needs to be notified in case you become incapacitated?
When it is determined you are no longer capable of making your own decisions, a written copy of the declaration will be sent to you and to your decision maker. If there are other individuals you want to be notified, include them here.

Additional Instructions
17.1 Do you want to include additional instructions?
No additional instructions are needed for most people.
Type your additional wishes, instructions or beliefs here:
Acknowledgment
17.2 Do you want your decision maker to sign and acknowledge your Personal Directive?

Guidelines
What instructions can be provided?
You may want to provide instructions about other issues that concern you. Some examples are:
- Who you want to be with you during your final moments.,
- Who you would prefer not to be present during your illness.
- Who will care for your pets during your illness.
What instructions CANNOT be provided?
Remember:
- You cannot refuse drugs intended for pain relief.
- You cannot refuse nourishment by mouth.
- Finally, you cannot request treatment that your medical team thinks is inappropriate.
Do you want your decision maker to sign and acknowledge your Personal Directive?
In Alberta it is not required that your Agent sign your Personal Directive. Your Agent's signature does not create a binding obligation and your Agent could never be forced to make a decision concerning your personal care that they are not comfortable with. However it is important that your Agent know that you have designated them as Agent and that your Agent be familiar with the contents of your Personal Directive as well as their obligations under the Alberta Personal Directives Act.

Signing Details
18.1 When will you sign this Personal Directive?
Date
Date Format: MM slash DD slash YYYY
18.2 Are you physically incapable of signing this document yourself?
Where you are physically incapable of signing this Personal Directive, another person may sign for you.
Total Payment:
Price: $ 299.00 CAD
Enter the following information regarding the person who will sign on your behalf:
Full Name
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Guidelines
Who can be a witness?
A witness to a Personal Directive cannot be a person designated in the directive as an agent, the spouse or adult interdependent partner of an agent, the spouse or adult interdependent partner of the Maker, a person who signs the directive on behalf of the Maker, or the spouse or adult interdependent partner of someone who signs the directive on behalf of the Maker.
Who can be an agent?
A person who signs on behalf of the Maker cannot be a person designated in the directive as an agent or the spouse or adult interdependent partner of a person of an agent.

Final Check: Please Review Carefully
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Step 1 of 20 - Get Started

Details Info

Guidelines

Decision Maker

Guidelines

Your Decision Maker

Second Decision Maker

Third Decision Maker

Fourth Decision Maker

Fifth Decision Maker

Guidelines

Decision Making Method

Guidelines

Duties and Authority

Guidelines

Healthcare Instructions

Terminal Condition

Guidelines

Persistent Unconsciousness

Guidelines

Severe and Permanent Mental Impairment

Guidelines

Other Treatments

Indicate your consent or refusal to each of the following treatments

Guidelines

Comfort and Dignity

Organ Donation

Guidelines

Statement of Values and Beliefs

Guidelines

Specific Instructions

Guidelines

Determination of Incapacity

Primary Individual

Second Individual

Third Individual

Guidelines

Confidential Information

Care of Minors

Primary Agent

Second Agent

Third Agent

Revoke Previous Directives

Revocation of Current Directive

Guidelines

Notification of Incapacity

Primary Person to Notify

Second Person to Notify

Third Person to Notify

Fourth Person to Notify

Fifth Person to Notify

Guidelines

Additional Instructions

Acknowledgment

Guidelines

Signing Details

Enter the following information regarding the person who will sign on your behalf:

Guidelines

Final Check: Please Review Carefully