09 LC 33
2811
House
Bill 339
By:
Representatives Gardner of the
57th,
Ralston of the
7th,
Oliver of the
83rd,
Lindsey of the
54th,
Stephenson of the
92nd,
and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Title 37 of the Official Code of Georgia Annotated, relating to mental
health, so as to provide a means for a competent adult to control either
directly through instructions written in advance or indirectly through
appointing an agent to make mental health care decisions on behalf of such
person according to a written psychiatric advance directive; to provide a short
title; to provide definitions; to provide for standards and limitations with
respect to psychiatric advance directives; to provide for the responsibilities
and duties of physicians and other mental health care providers and agents under
psychiatric advance directives; to provide a statutory psychiatric advance
directive form; to provide for construction of such form; to provide for
applicability; to provide for statutory construction of chapter; to provide for
related matters; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Title
37 of the Official Code of Georgia Annotated, relating to mental health, is
amended by adding a new chapter to the end of such title to read as
follows:
"CHAPTER
11
37-11-1.
This
chapter shall be known and may be cited as the 'Psychiatric Advance Directive
Act.'
37-11-2.
As
used in this chapter, the term:
(1)
'Attending physician' means the physician who has primary responsibility at the
time of reference for the treatment and care of the patient.
(2)
'Competent adult' means a person of sound mind who is 18 years of age or
older.
(3)
'Declarant' means the person executing a psychiatric advance directive pursuant
to this chapter.
(4)
'Hospital' means:
(A)
A facility which has a valid permit or provisional permit issued under Chapter 7
of Title 31 and which is primarily engaged in providing to inpatients, by or
under the supervision of physicians, diagnostic services and therapeutic
services for medical diagnosis, treatment, and care of injured, disabled, or
sick persons;
(B)
A state owned, state operated, or private facility providing services which
include, but are not limited to, inpatient care and the diagnosis, care, and
treatment or habilitation of persons with:
(i)
Mental or emotional illness;
(ii)
Developmental disability, as defined in Code Section 37-2-2; or
(iii)
Addictive disease, as defined in Code Section 37-2-2.
Such
hospital may also provide or manage state owned or operated programs in the
community;
(C)
An emergency receiving facility, as defined in Code Section 37-3-1;
and
(D)
An evaluating facility, as defined in Code Section 37-3-1.
(5)
'Incapable' means that, in the opinion of the court in a guardianship proceeding
or in the opinions of two physicians or a physician and a psychologist who have
personally examined the patient, a person's ability to receive and evaluate
information effectively or communicate decisions is impaired to such an extent
that the person currently lacks the capacity to make mental health care
decisions.
(6)
'Mental health care' means any care, treatment, service, or procedure to
maintain, diagnose, treat, or provide for the patient's mental
health.
(7)
'Mental health care agent' or 'agent' means a person appointed by a declarant
pursuant to this chapter to act for and on behalf of the declarant to make
decisions related to mental health care when the declarant is incapable. This
term shall include any alternate mental health care agent appointed by the
declarant.
(8)
'Mental health care provider' or 'provider' means the attending physician and
any other person administering mental health care to the patient at the time of
reference who is licensed, certified, or otherwise authorized or permitted by
law to administer mental health care in the ordinary course of business or the
practice of a profession, including but not limited to psychologists, clinical
social workers, and clinical nurse specialists in psychiatric/mental health, and
any person employed by or acting for any such authorized person.
(9)
'Patient' means the declarant.
(10)
'Physician' means a person licensed to practice medicine under Article 2 of
Chapter 34 of Title 43.
(11)
'Prospective consent' means consent given by a competent adult that is valid for
treatment at a time when a person is incapable.
(12)
'Psychiatric advance directive' or 'directive' means an agency governing any
type of mental health care for and on behalf of a patient and refers to the
power of attorney or other written instrument defining the agency, or the agency
itself, as appropriate to the context.
(13)
'Skilled nursing facility' means a facility which has a valid permit or
provisional permit issued under Chapter 7 of Title 31 and which provides skilled
nursing care and supportive care to patients whose primary need is for
availability of skilled nursing care on an extended basis.
(14)
'State-wide hot line' means a state-wide, toll-free hot line available 24 hours
per day, 7 days per week, managed and funded by the State of Georgia for mental
health and addiction crises.
37-11-3.
(a)
A competent adult may execute a psychiatric advance directive of preferences or
instructions regarding his or her mental health care. The directive may
include, but is not limited to, consent to or refusal of specified mental health
care.
(b)(1)
A competent adult may choose not to appoint a mental health agent, in which case
the instructions and desires of the declarant shall be followed.
(2)
A psychiatric advance directive may designate a competent adult to act as agent
to make decisions about mental health care for the declarant. An alternative
agent may also be designated to act as agent if the original designee is unable
or unwilling to act at any time. An agent who has accepted the appointment in
writing may make decisions about mental health care on behalf of the declarant
only when the declarant is incapable. In exercising authority under the
directive, the agent shall make such decisions consistent with the instructions
and desires of the declarant, as expressed in the directive.
(c)
A directive shall be effective only if it is signed by the declarant and two
competent adult witnesses. The witnesses shall attest that the declarant is
known to them, signed the directive in their presence, appears to be of sound
mind, and is not under duress, fraud, or undue influence. Persons specified in
subsection (e) of Code Section 37-11-4 may not act as witnesses.
(d)
A directive shall become effective when it is delivered to the declarant's
physician or other mental health care provider and shall remain in effect unless
otherwise specified in the directive or until revoked by the declarant. The
physician or provider shall be authorized to act in accordance with a directive
when the declarant has been found to be incapable. The physician or provider
shall continue to obtain the declarant's informed consent to all mental health
care decisions if the declarant is capable of providing informed consent or
refusal.
(e)(1)
An agent shall not have authority to make mental health care decisions unless
the declarant is incapable.
(2)
An agent shall not be, solely as a result of acting in that capacity, personally
liable for the cost of treatment provided to the declarant.
(3)
Except to the extent that a right is limited by a directive or by any federal
law, an agent shall have the same right as the declarant to receive information
regarding the proposed mental health care and to receive, review, and consent to
disclosure of medical records relating to that care. This right of access shall
not waive any evidentiary privilege.
(4)
An agent shall not be subject to criminal prosecution, civil liability, or
professional disciplinary action for any action taken in good faith pursuant to
a psychiatric advance directive.
(f)
The authority of a named agent and any alternative agent shall continue in
effect so long as the directive appointing the agent is in effect or until the
agent has withdrawn.
(g)
A person may not be required to execute or to refrain from executing a directive
as a criterion for insurance, as a condition for receiving mental or physical
health care services, or as a condition of discharge from a hospital or skilled
nursing facility.
37-11-4.
(a)
Upon being presented with a psychiatric advance directive, a physician shall
make the directive a part of the declarant's medical record. When acting under
authority of a directive, a physician or other provider shall comply with it to
the fullest extent possible, consistent with reasonable medical practice, the
availability of treatments requested, and applicable law. If the physician or
other provider is unwilling at any time to comply with the directive, the
physician or provider shall promptly notify the declarant and the agent and
document the notification in the declarant's medical record.
(b)
A physician or provider may subject a declarant to mental health treatment in a
manner contrary to the declarant's wishes, as expressed in a psychiatric advance
directive, only if:
(1)
A court order contradicts the declarant's wishes as specified in the psychiatric
advance directive; or
(2)
The declarant presents a substantial risk of imminent harm to himself or herself
or to others.
(c)
A directive shall not limit any authority to take a person into custody or admit
or retain a person in the custody of a local mental health authority pursuant to
Article 3 of Chapter 11 of Title 37 or any other applicable law.
(d)
A directive may be revoked in whole or in part by the declarant at any time so
long as the declarant is not incapable. Such revocation shall be effective when
the declarant communicates the revocation to the attending physician or other
provider. The attending physician or other provider shall note the revocation
as part of the declarant's medical record.
(e)
None of the following persons may serve as an agent or as witnesses to the
signing of a directive:
(1)
The declarant's attending physician or mental health care provider or an
employee of that physician or provider;
(2)
An employee of the Department of Human Resources or of a local mental health
authority or any organization that contracts with a local mental health
authority; provided, however, that this shall not apply to family members,
friends, or other associates of the declarant if the declarant so
wishes.
(f)
An agent may withdraw by giving written notice to the declarant. If a declarant
is incapable, the agent may withdraw by giving written notice to the attending
physician or provider. The attending physician shall note the withdrawal as part
of the declarant's medical record.
37-11-5.
(a)
The statutory psychiatric advance directive form contained in this subsection
may be used to grant an agent powers with respect to the declarant's own mental
health care; but the statutory psychiatric advance directive form is not
intended to be exclusive or to cover delegation of a parent's power to control
the mental health care of a minor child, and no provision of this chapter shall
be construed to bar use by the declarant of any other or different form of
directive or power of attorney for mental health care that complies with the
provisions of this chapter. If a different form of psychiatric advance
directive is used, it may contain any or all of the provisions set forth or
referred to in the following form. When a directive in substantially the
following form is used, and notice substantially similar to that contained in
the form below has been provided to the patient, it shall have the same meaning
and effect as prescribed in this chapter. Substantially similar forms may
include forms from other states. The statutory psychiatric advance directive
may be included in or combined with any other form of advance directive
governing property or other matters, and no provision of this chapter shall be
construed to bar use by the declarant of a durable power of attorney for health
care form pursuant to Chapter 36 of Title 31, either solely or in addition to
the form contained in this subsection.
Psychiatric
Advance Directive
Name:
__________________________________________________
Date: ___________________________________________________
Date: ___________________________________________________
Mental
Health Care Agent:
Name:
__________________________________________________
Address: _________________________________________________
_________________________________________________________
Day Phone Number: ________________________________________
Address: _________________________________________________
_________________________________________________________
Day Phone Number: ________________________________________
Evening
Phone Number:
______________________________________________
STATEMENT
OF INTENT
I,
(your
name)
, being of sound mind, willfully and voluntarily execute this psychiatric
advance directive to assure that, during periods of incapacity resulting from
psychiatric illness, my choices regarding my mental health care will be carried
out despite my inability to make informed decisions on my own behalf. In the
event that a decision maker is appointed by a court to make mental health care
decisions for me, I intend this document to take precedence over all other means
of ascertaining my intent while competent.
By
this document, I intend to create a psychiatric advance directive as authorized
by state law, the U.S. Constitution and the federal Patient Self-Determination
Act of 1990 (P.L. 101-508) to indicate my wishes regarding mental health
treatment. I understand that this directive will become operative upon my
incapacity to make my own mental health decisions and shall continue in
operation only during that incapacity.
I
intend that this document should be honored whether or not my agent dies or
withdraws or if I have no agent appointed at the time of the execution of this
document.
Incomplete
sections in this psychiatric advance directive (i.e., not completed certain
sections) should not affect its validity in any way. I intend that all completed
sections be followed.
If
any part of this psychiatric advance directive is invalid or ineffective under
relevant law, this fact should not affect the validity or effectiveness of the
other parts. It is my intention that each part of this psychiatric advance
directive stand alone. If some parts of this document are invalid or
ineffective, I desire that all other parts be
followed.
I
intend this psychiatric advance directive to take precedence over any and all
living will documents and/or durable power of attorney for health care documents
and/or other advance directives I have previously executed, to the extent that
they are inconsistent with this document.
Name:
___________________________________________________________
Instructions
Included in My Psychiatric Advance
Directive
Put your initials in the space next to each section you have completed.
Put your initials in the space next to each section you have completed.
_______
Designation of my mental health care
agent.
_______ Designation of alternate mental health care agent.
_______ Authority granted to my mental health care agent.
_______ When spouse is mental health care agent.
_______ Symptoms.
_______ When my plan is no longer needed.
_______ Clinicians.
_______ Medications.
_______ Hospitalization is not my first choice.
_______ Treatment facilities.
_______ Acceptable interventions.
_______ Preferred interventions.
_______ Help from others.
_______ State-wide hot line.
_______ Prospective Consent.
_______ Signature page.
_______ Record of psychiatric advance directive.
_______ Designation of alternate mental health care agent.
_______ Authority granted to my mental health care agent.
_______ When spouse is mental health care agent.
_______ Symptoms.
_______ When my plan is no longer needed.
_______ Clinicians.
_______ Medications.
_______ Hospitalization is not my first choice.
_______ Treatment facilities.
_______ Acceptable interventions.
_______ Preferred interventions.
_______ Help from others.
_______ State-wide hot line.
_______ Prospective Consent.
_______ Signature page.
_______ Record of psychiatric advance directive.
APPOINTMENT
OF AGENT FOR MENTAL HEALTH
CARE
If you do not wish to appoint an agent, do not complete the sections below.
If you do not wish to appoint an agent, do not complete the sections below.
Make
sure you give your agent a copy of all sections of this document.
Statement
of Intent to Appoint an Agent:
I,
(your
name)
, being of sound mind, authorize a mental health care agent to make certain
decisions on my behalf regarding my mental health treatment when I do not have
the capacity to do so. I intend that those decisions should be made in
accordance with my expressed wishes as set forth in this document. If I have not
expressed a choice in this document, I authorize my agent to make the decisions
that my agent determines are the decisions I would make if I had the capacity to
do so.
Designation
of Mental Health Care
Agent
A. I hereby designate and appoint the following person as my agent to make mental health care decisions for me as authorized in this document. In the event that admission for psychiatric treatment is being considered, my agent must be notified/consulted before any decision is finalized.
A. I hereby designate and appoint the following person as my agent to make mental health care decisions for me as authorized in this document. In the event that admission for psychiatric treatment is being considered, my agent must be notified/consulted before any decision is finalized.
Name:
__________________________________________________________________
Address: ________________________________________________________________
________________________________________________________________________
Day Phone Number ________________ Evening Phone Number______________________
Address: ________________________________________________________________
________________________________________________________________________
Day Phone Number ________________ Evening Phone Number______________________
B.
Agent's Acceptance: I hereby accept the designation as agent
for
(Your
name)
_____________________________________________________________
(Your
agent's
signature)____________________________________________________
I certify that I do not, have not, and will not provide care and treatment for this person.
I certify that I do not, have not, and will not provide care and treatment for this person.
Designation
of Alternate Mental Health Care
Agent
If the person named above is unavailable or unable to serve as my agent, I hereby appoint and desire immediate notification of my alternate agent as follows:
If the person named above is unavailable or unable to serve as my agent, I hereby appoint and desire immediate notification of my alternate agent as follows:
Name:
__________________________________________________________________
Address: ________________________________________________________________
________________________________________________________________________
Day Phone Number ________________ Evening Phone Number______________________
Address: ________________________________________________________________
________________________________________________________________________
Day Phone Number ________________ Evening Phone Number______________________
Alternate
Agent's Acceptance: I hereby accept the designation as alternate agent for
(Your
name)
______________________________________________________________
(Your
agent's
signature)____________________________________________________
I certify that I do not, have not, and will not provide care and treatment for this person.
I certify that I do not, have not, and will not provide care and treatment for this person.
Authority
Granted to My Mental Health Care
Agent
Initial if you agree with a statement; leave blank if you do not.
Initial if you agree with a statement; leave blank if you do not.
A.
________ If I become incapable of giving consent to mental health care
treatment, I hereby grant to my agent full power and authority to make mental
health care decisions for me, including the right to consent, refuse consent, or
withdraw consent to any mental health care, mental health care treatment, mental
health care provider, or mental health care service or procedure, consistent
with any instructions and/or limitations I have set forth in this psychiatric
advance directive. If I have not expressed a choice in this advance directive, I
authorize my agent to make decisions that my agent determines are the decisions
I would make if I had the capacity to do
so.
B._________
If I am incapable of authorizing the release of my medical records, I hereby
grant to my agent full power and authority to request these records on my
behalf.
C.
_________ If I choose to discharge or replace my agent, all other provisions of
this psychiatric advance directive shall remain in effect and shall only be
revocable or changeable by me.
When
Spouse Is Mental Health Care Agent and If There Has Been a Legal Separation,
Annulment, or Dissolution of the Marriage
Initial if you agree with this statement; leave blank if you do not.
Initial if you agree with this statement; leave blank if you do not.
__________
I desire the person I have named as my agent, who is now my spouse, to remain as
my agent even if we become legally separated or our marriage is
dissolved.
The
following sections outline when my psychiatric advance directive should be
activated, when it no longer needs to be used, and details regarding my care,
treatment, and preferred
interventions.
Symptoms
When I exhibit the following symptoms or behaviors, this would indicate that my psychiatric advance directive needs to be enacted:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Symptoms
When I exhibit the following symptoms or behaviors, this would indicate that my psychiatric advance directive needs to be enacted:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
When
My Plan Is No Longer
Needed
When I exhibit the following behaviors, my plan no longer needs to be utilized:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
When I exhibit the following behaviors, my plan no longer needs to be utilized:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Clinicians
The names of my doctors, therapists, pharmacists, and service providers and their telephone numbers are:
The names of my doctors, therapists, pharmacists, and service providers and their telephone numbers are:
Name
Phone
#
________________________________________________________________________________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I
prefer treatment from the following clinicians:
Name
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I
prefer not to be treated by the following clinicians:
Name
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Medications
(include all medications, whether for mental health care treatment or general health care treatment)
I am currently using the following medications for:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(include all medications, whether for mental health care treatment or general health care treatment)
I am currently using the following medications for:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
If
additional medications become necessary, I prefer to take the following
medications:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I
cannot tolerate the following medications
because:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I
am allergic to the following medications:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Hospitalization
is not my first
choice
It is my intention, if possible, to stay at home or in the community with the following supports:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
It is my intention, if possible, to stay at home or in the community with the following supports:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Treatment
Facilities
If it becomes necessary for me to be hospitalized, I would prefer to be treated at the following facilities:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
If it becomes necessary for me to be hospitalized, I would prefer to be treated at the following facilities:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I
do not wish to be treated at the following
facilities:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Acceptable
Interventions:
(Please
place your initials in the
blanks)
Medication
in pill form
Yes
________No ________
Liquid
medication
Yes
________No ________
Medication
by injection
Yes
________No ________
Seclusion
Yes
________No ________
Physical
restraints
Yes
________No ________
Seclusion
and physical restraints
Yes
________No ________
Experimental
treatment
Yes
________No ________
Electroconvulsive
therapy
(ECT) Yes
________No ________
____
I consent to the administration of electroconvulsive therapy with the following
conditions:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Acceptable
Preferred
Interventions:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Prospective
consent
At a time when I am incapable of making mental health care decisions, and no agent is available, I intend for this document to constitute authorization and informed consent for treatment that is consistent with the preferences I have expressed in this document and is medically indicated.
At a time when I am incapable of making mental health care decisions, and no agent is available, I intend for this document to constitute authorization and informed consent for treatment that is consistent with the preferences I have expressed in this document and is medically indicated.
Yes____________
(Initials)
No___________
Specific limitations on consent: _______________________________________________
________________________________________________________________________
Specific limitations on consent: _______________________________________________
________________________________________________________________________
Help
from
Others
List your supporters and the ways they can help you. Be sure to write their names, phone numbers, and responsibilities (mail, bills, pet, child care, etc.).
List your supporters and the ways they can help you. Be sure to write their names, phone numbers, and responsibilities (mail, bills, pet, child care, etc.).
Name
Phone
Number
Responsibility
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
State-wide
Hot Line
I am submitting a copy of this psychiatric advance directive to the state-wide hot line, which has my permission to access such directive if contacted by me or someone else on my behalf to assist in informing health care providers of my preferences listed in this directive when appropriate. Such hot line may also share this directive with a hospital physician if I present for evaluation.
I am submitting a copy of this psychiatric advance directive to the state-wide hot line, which has my permission to access such directive if contacted by me or someone else on my behalf to assist in informing health care providers of my preferences listed in this directive when appropriate. Such hot line may also share this directive with a hospital physician if I present for evaluation.
Name
of hot line:
__________________________________________________________
Date submitted to hot line: __________________________________________________
Date submitted to hot line: __________________________________________________
I
signed this psychiatric advance directive on (date)
__________________.
Any plan with a more recent date supersedes this one.
Signed ____________________________________________ Date _________________
Witness ___________________________________________ Date _________________
Witness ___________________________________________ Date _________________
(for use by the notary)
STATE OF____________________, County of__________________________________
Subscribed and sworn to or affirmed before me by the Principal,
______________________________________________________,
and (names of witnesses)
___________________________________________________ and
___________________________________________________,
witnesses, as the voluntary act and deed of the Principal, this ______ day of___________.
____________________.
My commission expires:
_______________________________________________________
_______________________________________________________
Notary Public
Any plan with a more recent date supersedes this one.
Signed ____________________________________________ Date _________________
Witness ___________________________________________ Date _________________
Witness ___________________________________________ Date _________________
(for use by the notary)
STATE OF____________________, County of__________________________________
Subscribed and sworn to or affirmed before me by the Principal,
______________________________________________________,
and (names of witnesses)
___________________________________________________ and
___________________________________________________,
witnesses, as the voluntary act and deed of the Principal, this ______ day of___________.
____________________.
My commission expires:
_______________________________________________________
_______________________________________________________
Notary Public
Record
of Psychiatric Advance Directive
I
have given copies of my psychiatric advance directive to:
Name/Location: ______________________________________________________
Address: ______________________________________________________
Phone
Numbers: ______________________________________________________
Name/Location: ______________________________________________________
Address: ______________________________________________________
Phone
Numbers: ______________________________________________________
Name/Location: ______________________________________________________
Address: ______________________________________________________
Phone
Numbers: ______________________________________________________
Name/Location: ______________________________________________________
Address: ______________________________________________________
Phone
Numbers: ______________________________________________________
Name/Location: ______________________________________________________
Address: ______________________________________________________
Phone
Numbers: ______________________________________________________
Name/Location: ______________________________________________________
Address: ______________________________________________________
Phone
Numbers: ______________________________________________________
Name/Location: ______________________________________________________
Address: ______________________________________________________
Phone
Numbers: ______________________________________________________
Name/Location: ______________________________________________________
Address: ______________________________________________________
Phone
Numbers: ______________________________________________________
(b)
The statutory psychiatric advance directive form provided in subsection (a) of
this Code section authorizes, and any different form of mental health care
agency may authorize, the agent to make any and all mental health care decisions
on behalf of the declarant which the declarant could make if present and under
no disability, incapacity, or incompetency, subject to any limitations on the
granted powers that appear on the face of the form, to be exercised in such
manner as the agent deems consistent with the intent and desires of the
declarant. The agent shall be under no duty to exercise granted powers or to
assume control of or responsibility for the declarant's mental health care; but,
when granted powers are exercised, the agent shall be required to use due care
to act for the benefit of the declarant in accordance with the terms of the
psychiatric advance directive. The agent may not delegate authority to make
mental health care decisions. The agent may sign and deliver all instruments,
negotiate and enter into all agreements, and do all other acts reasonably
necessary to implement the exercise of the powers granted to the agent. Without
limiting the generality of the foregoing, the statutory psychiatric advance
directive form shall, and any different form of mental health care agency may,
include the following powers, subject to any limitations appearing on the face
of the form:
(1)
The agent is authorized to consent to and authorize or refuse, or to withhold or
withdraw consent to, any and all types of medical care, treatment, or procedures
relating to the mental health of the declarant, including any medication
program;
(2)
The agent is authorized to admit the declarant to or discharge the declarant
from any and all types of hospitals, institutions, homes, residential or nursing
facilities, treatment centers, and other health care institutions providing
mental health care or treatment for any type of mental condition;
(3)
The agent is authorized to contract for any and all types of mental health care
services and facilities in the name of and on behalf of the declarant, and the
agent shall not be personally liable for any services or care contracted for on
behalf of the declarant; and
(4)
At the declarant's expense and subject to reasonable rules of the mental health
care provider to prevent disruption of the declarant's mental health care, the
agent shall have the same right the declarant has to examine and copy and
consent to disclosure of all the declarant's medical records that the agent
deems relevant to the exercise of the agent's powers, whether the records relate
to mental health or any other medical condition and whether they are in the
possession of or maintained by any physician, psychiatrist, psychologist,
therapist, hospital, skilled nursing facility, or other health care provider,
notwithstanding the provisions of any statute or other rule of law to the
contrary. This authority shall include all rights that the declarant has under
the federal Health Insurance Portability and Accountability Act of 1996
('HIPAA'), P.L. 104-191, and its implementing regulations regarding the use and
disclosure of individually identifiable health information and other medical
records.
37-11-6.
Any
physician or other mental health care provider who provides treatment consistent
with the preferences expressed by a patient in a psychiatric advance directive
shall be deemed to have acted with appropriate authorization and informed
consent for such care if the following conditions are met: (a) the patient is
incapable, (b) no designated agent is available, and (c) the patient's
psychiatric advance directive indicates that the patient gave prospective
consent. No such physician or other mental health care provider acting in good
faith shall be subject to liability for such care on the grounds that
authorization or informed consent was not obtained from the patient at the time
of treatment.
37-11-7.
(a)
This chapter applies to all mental health care providers and other persons in
relation to all mental health care agencies or directives executed on and after
July 1, 2009. This chapter supersedes all other provisions of law or parts
thereof existing on July 1, 2009, to the extent such other provisions are
inconsistent with the terms and operation of this chapter, provided that this
chapter does not affect the provisions of law governing emergency health care.
If the declarant has executed a durable power of attorney for health care
pursuant to Chapter 36 of Title 31, as now or hereafter amended, the declarant
shall indicate within either document which is to take precedence with regard to
mental health care decisions.
(b)
This chapter does not in any way affect or invalidate any directive executed or
any act of an agent prior to July 1, 2009, or affect any claim, right, or remedy
that accrued prior to July 1, 2009.
(c)
This chapter is wholly independent of the provisions of Title 53, relating to
wills, trusts, and the administration of estates, and nothing in this chapter
shall be construed to affect in any way the provisions of said Title
53."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.