Promoting Excellence : Advanced Directive Intervention List

Instrument Name:
Sutter VNA & Hospice: Advanced Directive Intervention List

An advanced directive check-list of choices for those patients confronted with life threatening illness.

Clinical Care Tools – Advance Care Planning

Sutter VNA and Hospice
1900 Powell St, Suite 300
Emeryville CA 94608

Brad Stuart M.D.
[email protected]

How the grantee used this instrument:
Patients entering hospice care were asked to fill out the check-list of possible responses to their condition if it should worsen.

advance care plan, advance directives, decision-making, preferences, care plan

To use this tool:
You may print and copy this tool for your own use from this site. Please credit source.

Developed specifically for this project by the project team.

To view this tool:
To view the tool in your browser left-click on the link below or to download to your computer right-click on the link.
pdf PDF 240 KB / 1 page

Sutter VNA and Hospice overview page

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit for more resources.

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