IMPORTANT FORMS | Salt Spring Hospice Society

Advance Care Planning Forms

Download official and easy-to-use advance care planning forms to record your future health care wishes and choose a trusted decision-maker.

Emergency Information Form

Includes personal identification information, emergency contacts, medical conditions and medications.

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Temporary Substitute Decision Maker Form

Includes a list of Subsitute Decision Makers.

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MOST

Medical Order of Scope of Treatment

Outlines your exact choices for life-support and emergency medical care if you become unable to speak for yourself

MOST - Explanation Sheet

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MOST - Form

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DNR

No Cardiopulmonary Resuscitation

Allows patients to request no CPR administered should their heart or breathing stop.

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Representation Agreement

(RA9)

For adults with full mental capability, granting comprehensive decisions over health, personal care and end-of-life decisions.

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Representative Agreement

(RA7)

For adults whose full mental capability is in question or declining. It grants limited, routine decisions.

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Enduring Power of Attorney

Legal document that lets you appoint someone you trust (your 'attorney') to manage your financial and legal affairs if you become incapable or unable to do so yourself.

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Representative Agreement

This document provides a legal way for you to name someone to make health care and personal care decisions for you when you are unable to speak for yourself.

Island Health MOST Pamphlet

Medical Orders for Scope of Treatment (MOST). This pamphlet explains MOST.

Island Health MOST Form

In an emergency or urgent situation, if you are unable to express your wishes, a MOST will help ensure your health care treatment aligns with your wishes.

Emergency Information Form

A detailed form to list all your medical information and who to contact in the event of an emergency

Advance Care Planning Tools

Advance Care Planning Forms

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