Advance Directives

420-5-19 Advance Directives

Surrogate health care decision-makers, as authorized by Act 97-187, shall complete the form attached hereto as Appendix I, which, when properly completed and duly notarized, shall constitute the certification of the surrogate as required by the act and shall authorize the surrogate, including a representative of the ethics committee or another duly appointed committee at the facility where the patient is being treated, acting by unanimous consent as the surrogate, to make standard health care decisions for the patient as well as to make decisions regarding the providing, withholding, or withdrawal of life-sustaining treatment and artificially provided nutrition and hydration in instances involving terminal illness or injury and permanent unconsciousness. This form is to be used to fulfill the purposes of Act 97-187.

Certification of Health Care Decision Surrogate

An amendment to Appendix I (Certification of Health Care Decision Surrogate) was published on August 31, 2022, and became effective on October 15, 2022.

• Appendix I: Certification of Health Care Decision Surrogate

Portable Do Not Attempt Resuscitation Order Reminder

Health Provider Standards shares this reminder with Alabama hospitals, nursing homes, assisted living facilities, specialty care assisted living facilities, and providers.

In 2016, the Alabama Legislature passed Act #2016-96, amending Alabama's Natural Death Act to create a valid portable Do Not Attempt Resuscitation (DNAR) order that transfers from one health care facility to the next facility if it is issued using a properly completed and executed form found in the Alabama Department of Public Health's Administrative Rule 420-5-19, Appendix II. The form requires the following:

• Patient's name;
• Patient's date of birth;
• One of the following;
  • Patient/resident signature/consent that resuscitative measures be withheld in the event of cardiopulmonary cessation;
  • Advance Directive with instructions regarding life-sustaining treatment and the signature of a facility/provider attesting that the patient/resident is not competent or is no longer able to understand, appreciate, and direct his/her medical treatment and has no hope of regaining that ability
  • Health Care Proxy/Attorney in Fact consent OR
  • Surrogate consent; AND
  • Physician's signature and date of signature.

The completed DNAR must be made a part of the patient's medical record, and the DNAR order becomes portable to other health care providers. The burden is on the transferring provider/facility to communicate the DNAR order to the receiving facility and ensure a copy of the order accompanies the patient during transport to the receiving facility.

"Facility-specific DNARs" can continue to be entered and followed; however, they will not be portable to other health care providers. For more information, please see the following links.

• Alabama Portable Physician Do Not Attempt Resuscitation Order
• Frequently Asked Questions: The New Portable Physician's DNAR Order and Rule
• The New Portable Do Not Resuscitate Order