Promoting Excellence : Values History Form

Huntington's Disease Workgroup: Values History Form

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

Clinical Care Tools - Advance Care Planning

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

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.

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.

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 for more resources.

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