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Green Sleeve for Advance Care Planning

Think of a Green Sleeve as your personal medical passport. It is a protective plastic folder designed to keep your important health documents safe, organized, and easily accessible whenever they are needed. It bridges the gap between home and the hospital, making sure everyone in your circle of care can instantly see your most up-to-date healthcare choices. We ask you to stick this folder right on your refrigerator; that way, if paramedics are ever called to your home, they will know exactly where to find your medical wishes. 

Forms & Resources
Your Green Sleeve includes the documents below. Ask your doctor or pharmacist to give you a complete list of your medications and include those as well.

Emergency Information Form​​​

Detailed basic information regarding the person the Green Sleeve is created for.

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Representation Agreement (Section 9)

For adults who are 'competent' to understand. 

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Representation Agreement (Section 7)

For adults whose mental capability to understand is in question.​

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No CPR Form

Instruction to not try to revive if their heart or breathing stops. Formally known as a Do-Not-Resuscitate (DNR) order.

 

MOST Form

Def: Medical Orders for Scope of Treatment) is a clinical medical order that translates a persons goals of care into actionable instructions for healthcare providers.

 

MOST Pamphlet

Detailed information about Medical Orders for Scope of Treatment.

 

My Voice: Advance Care Planning Guide

Provincial workbook and guide for Advance Care Planning (ACP) in British Columbia.​

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Medical Order of Scope of Treatment (MOST) Information

Salt Spring Hospice Society
202- 118 Fulford Ganges Rd,

Salt Spring Island, BC, V8K 2S4

Hours of Operation:

Mon-Fri: 9am-3pm

Excluding Stat Holidays

office@saltspringhospice.org

250-537-2770​

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