How the Center serves
patients and families.
West Virginians want their wishes respected and their pain controlled near the end of life. The Center for End-of-Life Care provides information to patients and families so that they can make informed choices and receive the treatment they want.
Start your advance directive today.
A living will is a legal document that tells your doctor how you want to be treated if you are terminally ill or permanently unconscious and cannot make decisions for yourself. In the past few years, 11% of West Virginians who have completed an advance directive have done this form.
Download the LIVING WILL FORM (PDF)
Medical Power of Attorney
A medical power of attorney is a legal document that allows you to name a person to make healthcare decisions for you if you are too sick to make them for yourself. In the past few years, 26% of West Virginians who have completed an advance directive have done this form.
Download the MEDICAL POWER OF ATTORNEY FORM (PDF)
Combined Living Will/Medical Power of Attorney
This one document combines both the living will and medical power of attorney documents and should be used if you want to name a health care decision maker and do not want machines and other medical interventions to keep you alive when you are dying or permanently unconscious. Most West Virginians (62%) who complete an advance directive complete this form.
Download the COMBINED LIVING WILL/MPA FORM (PDF)
e-Directive Registry Opt-In Form
If your advance directive or medical order is older and does not contain an “Opt-In” box at the top, the e-Directive Registry must have your permission to include your documents in the Registry. Additional information about you is also needed to place your forms in the Registry so that you will not be confused with another person who has the same name. Click on the link below for the necessary form and send it to the Registry with your documents.
Download the E-DIRECTIVE REGISTRY OPT-IN FORM (PDF)
Request Copies of Your Forms in the e-Directive Registry
You or your legal representative* may request copies of your advance directive documents or medical orders that are contained in the WV e-Directive Registry. To receive a copy, please complete the form below and mail or FAX it along with a copy of your federally issued photo ID (for verification). Upon receipt of this form and your photo ID, the Registry will send you copies of all documents that the Registry has on file for you by the method you indicate on the form. Please note: forms cannot be emailed.
*Legal representative must have Medical Power of Attorney form or surrogate form on file with the Registry or submit the form with the request.
Download the PATIENT RELEASE OF INFORMATION FORM
Medical Orders (DNR and POST forms)
The do-not-resuscitate (DNR) card is a medical order to inform health care providers and first responders not to do CPR. The POST form is a medical order form for people with serious illness issued by your physician to inform health care providers about your treatment wishes. It gives you more choices for the types of treatment you want and do not want than the DNR card.
Download SAMPLE DNR CARD (PDF)
Download SAMPLE POST FORM (PDF)
Advance Directive Revocation Form
The advance directive revocation form helps identify the specific forms you wish to revoke, or cancel, in the WV e-Directive Registry. This form is only for the e-Directive Registry and will not be made available to treating healthcare providers. It is important to notify your doctor of the forms you wish to revoke as well. You must retrieve and destroy, verbally revoke, or provide a written notice to revoke all copies of your advance directives.
Download the Advance Directive Revocation Form for the WV e-Directive Registry