Advance Care Planning
Sentara Healthcare and the Sentara Center for Healthcare Ethics are offering the community the opportunity to complete their Advance Care Plan (Advance Directive) and register it, free of charge, with our national Advance Directive Registry through the U.S. Living Will Registry. Wherever you go in the United States your Advance Care Plan will be accessible by healthcare professionals when needed to guide your medical care if you are unable to communicate your wishes or make your own decisions.
Advance Care Planning Guide
Please take the time to read this guide with information on Advance Care Planning in a question and answer format. Read additional information that may help you fill out your care plan.
Advance Care Plan
If you wish to complete your Advance Care Plan (Advance Directive) online, you may do so, then save and print this form. Or if you wish, simply print the form and complete it by hand.
Please note: North Carolina prohibits any of the following from witnessing an ACP: relatives by blood or marriage, anyone entitled to any portion of the patient's estate, the patient's attending physician, a licensed healthcare provider who is an employee of the attending physician, an employee of the health care facility in which the declarant/principal is a patient, or an employee of a nursing home or adult care home where the declarant/principal resides.
If you already have an Advance Care Plan (Advance Directive and would like to have it registered, these forms contain a Registration Agreement and complete instructions on where to send your Advance Care Plan and to have it registered with the U.S. Living Will Registry. Print this form, complete it and follow the instructions on the information sheet.
Patient Protest Attachment
Use only if you want to give your Healthcare Agent the right to override your protest should you protest treatment decisions after being declared to lack decisional capacity by your physician. Call the Sentara Center for Healthcare Ethics at 757-252-9550 if you need assistance or have more questions reference this provision.
Patient Life Sustaining Treatment During Pregnancy Attachment
If you wish to provide additional instructions or modifications to instructions you have already given regarding life-prolonging procedures that will apply if you are pregnant at the time your attending physician determines that you have a terminal condition, you may do so by completing this Attachment and attaching it to your Advance Care Plan. Call the Sentara Center for Healthcare Ethics at 757-252-9550 if you need assistance or have more questions reference this provision.
For assistance in completion of your Advance Care Plan or to ask questions, please call the Sentara Center for Healthcare Ethics at 757-252-9550 or contact the hospital chaplain at your nearest Sentara hospital.
State Advance Directive Forms - North Carolina
Advance Directive information for North Carolina residents.
The Sentara Center for Healthcare Ethics provides community service presentations to religious, spiritual or civic groups interested in learning more about Advance Care Planning. If you have any questions, please contact the center for assistance at 757-252-9550.
For additional information on Advance Care Planning and additional resources, visit the American Medical Association.
Have questions or need assistance with your Advance Care Plan?
Contact your Primary Care Physician.
Or if you prefer, we have trained, Certified Advance Care Planning Facilitators available to assist you. To schedule your appointment, please call the Sentara Center for Healthcare Ethics at 757-252-9550.
Sentara Center for Healthcare Ethics
4705 Columbus Street, Suite 303
Virginia Beach, Virginia 23462-7762