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Advance Directive

Upcoming Date of Service

Advance Directives are documents that allow you to state your wishes about medical care if you are unable to speak for yourself. This document also lets you name someone to make health decisions on your behalf any time you are unable to make your own medical decisions.


A summary of the Center policy on Advance Directives is as follows:


·         You have the right to make choices regarding life-sustaining treatment, including resuscitative measures.


·         Because your procedure here is elective, the Center cannot withhold treatment if an unexpected complication were to arise.


·         If there is a need to transfer you to a hospital for additional care measures beyond what we can provide, your Advance Directives will be in your record and honored at the hospital or with your next caregiver upon your arrival.


·         Please do not bring a blank Advanced Directive form to the Center. It must be completed and witnessed prior to your surgery if you wish to include it in your patient record.


Patients also have the right to make an Advance Directive to help ensure that the competent adult’s desires are honored if he or she becomes incapacitated.


Florida law, however, does not require the ASC (per Florida Statue 765.1105) to comply with a patient’s advance directive if it is “contrary to the provider’s or facility’s moral or ethical beliefs.” The Center will not honor a patient’s Advance Directive for that reason. We will attempt to resuscitate and transfer to a hospital in the event of deterioration in health status. Because of these beliefs, any patient who has a DNRO (Do Not Resuscitate Order) will be asked to speak with his physician to consider having the procedure performed at a different facility.


The Center staff is trained to provide patients with information on an advance directive or living will. The information provided is not advice, but a guide to information and forms related to an advance directive or living will. Information on state law and state approved forms will be available to patients who request additional information.

By signing below you agree you have read all the information provided above and understands the information provided to you.

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