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Filling out a form to document health care decisions.

Forms to Document Health Priorities & Choices

Available forms to appoint a health care agent, specify care and treatment preferences, submit documents to Vermont's Advance Directive Registry, and related to Vermont's law on medical aid in dying.

Advance Directives for Health Care & Medical Orders

Appointment of a Health Care Agent

Enables you to appoint a health care agent who will be authorized to make medical decisions for you if you are unable to speak for yourself.

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Advance Directive Short Form

Enables you to appoint a health care agent and provide detailed information about your health care goals and treatment priorities.

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Advance Directive Long Form

Enables you to appoint a health care agent, provide detailed instructions about your care, and includes provisions for those with mental health and/or psychiatric considerations.

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PREPARE for Your Care Advance Directive

Easy to read advance directive developed for Vermont by the PREPARE program based in California.

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Disability Rights Vermont Advance Directive

Produced by Disability Rights Vermont for individuals seeking to include information about mental health preferences and decisions.

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DNR/COLST Order

A medical order completed by your clinician to limit the use of life sustaining treatments at end of life. Based on your medical condition, your values, and your wishes.

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Forms to Submit Advance Directives to Vermont's Registry

Advance Directive Registry Agreement

Required to initially submit and register your advance directive. Allows for your document to be accessed electronically by providers nationwide.

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Advance Directive Registry Authorization to Change

Required when submitting your updated advance directive to your existing record within the Registry.

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Forms for Patient Choice & Control at End of Life (Act 39)

Physician Reporting

Enables a prescribing physician to document the legal steps required under Vermont's Medical Aid in Dying Law.

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Consulting Physician Reporting

Enables a consulting physician to document the legal steps required under Vermont's Medical Aid in Dying Law.

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Patient Written Request for Medication

Enables patients to complete the written request required by Vermont's Medical Aid in Dying Law.

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Physician Follow-Up Reporting

Required for prescribing physicians who write a prescription for a lethal dose of medication under Vermont's Medical Aid in Dying Law.

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