The Donor is the person who is appointing a decision maker under Advance Personal Plan.
The Decision Maker(s) are the person or persons the Donor wishes to appoint as their substitute decision maker.
My decision maker may act only in relation to:
My decision maker’s power is limited to the following matters only:
Note: If you are limiting your decision maker’s power to only paying debts, expenses and / or maintenance and accommodation expenses etc., then ensure that the decision maker is also provided with access to funds to be able to do that (for example, access to bank accounts etc).
Note: If you wish your decision makers to act in any other manner, please contact us.
Note: Decision makers may be appointed to act at all times, only in stated circumstances or at all times except in stated circumstances. We have provided some examples. If suitable, you may select any of them. If you wish to include other appointment options for your decisions maker(s), please contact us.
Note: Decision makers may be appointed subject to restrictions on authority, requirements to be complied with or specific directions. For example, “My decision makers are not authorised to invest in XYZ Pty Ltd shares” or “If I need nursing home care, I want my decision makers to try XYZ nursing home first” or “My decision maker must consult XYZ when making decisions in relation to my health care”.
If you do not wish to provide any restrictions, requirements or directions, please select ‘none’. Otherwise, we have provided some examples of restrictions, requirements and directions. If suitable, you may select any of them. If you wish to provide other restrictions, requirements or directions, please contact us.
I: SPECIFIC HEALTH CARE TREATMENT DIRECTIONS
You may include specific health care treatment directions in your advance personal plan. If you do not wish to include any such directions, please leave the section blank.
It is strongly recommended that before completing this section you discuss your options with your doctor who knows your medical history and views. The doctor will also be able to explain any medical terms that you are unsure about and will confirm that you were able to understand the decisions you have made in the document and that you made those decisions voluntarily.
II: OTHER SPECIFIC HEALTH CARE TREATMENT DIRECTIONS
You may list any treatment you would or would not want to have provided e.g. blood transfusions or antibiotics. We have provided some examples below. If suitable, you may select any of them. If you wish to include other treatments, please contact us. If you do not wish to list any treatments, please leave the section blank.
I: GENERAL STATEMENTS OF VIEWS, WISHES AND BELIEFS
You may include in this section things that matter to you, which you think may be relevant when you can no longer speak for yourself. We have provided some examples below. If suitable, you may select any of them. If you wish to include other wishes, please contact us. If you do not wish to include any views, wishes and beliefs, please leave this section blank.
II: GOALS FOR END OF LIFE CARE
(Include what you hope for most when you are near the end of your life. For example, family presence, access to items of significance, music, any personal, religious or cultural practices to be followed).
We have provided some examples below. If suitable, you may select any of them. If you wish to include other goals, please contact us. If you do not wish to include any goals for end of life, please leave this section blank.
If I am nearing death, I want the following:
Note: Your Advance Personal Plan allows you to make any comments in addition to the matters provided above. If you wish to include any additional comments in your Advance Personal Plan, please let us know.