Advance Directives

State Board of Health Administrative Code Chapter 420-5-19

Advance Directives

420-5-19-.01 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 in fulfillment of the purposes of Act 97-187.

• See Chapter 420-5-19 in full

Certification of Health Care Decision Surrogate

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

• Appendix I: Certification of Health Care Decision Surrogate