Promoting Excellence : Values History Form

Name:
Huntington's Disease Workgroup: Values History Form

Description:
This form provides individuals with the opportunity to address multiple personal preferences and issues.

Category:
Clinical Care Tools - Advance Care Planning

Source:
The Huntington's Disease Workgroup of
Promoting Excellence in End-of-Life Care
Richard Dubinsky, MD, Chair

Contact:
Richard Dubinsky, MD, MPH
Dept. of Neurology
University of Kansas Medical Center
Mail Stop 2012
3599 Rainbow, Blvd.
Kansas City, KS, 66160
[email protected]

Recommendation of the workgroup for use of this instrument:
This document, when completed and attached to a HD patient's Advance Directive, gives the appointed Health Care Agent and the physician a specific and comprehensive guide to desired care.

Keywords:
decision-making, care plan, HD, Huntington's Disease, values, preferences, advance directive, advance care plan

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

References:
Produced by the Health Sciences Ethics Program at the University of New Mexico

To view this tool:
The Values History Form is located on Appendix A (page 67) of the Huntington's Disease Recommendations to the Field (PDF) monograph.
pdf PDF 498 KB / 71 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted February 24, 2005


# HD02, type:advanced_care_planning


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 PromotingExcellence.org for more resources.

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