Who To Contact In an Emergency

In addition to appointing a spokesperson, you may want to communicate information about your emergency contacts. Are there certain people you want your health care providers to contact if you have a medical emergency or mental health crisis? Are there people you dont want your health care providers to contact?

Emergency Contacts? (Part 1 of 4)

I would like to have the following person (people) conatacted in case of a medical emergency(e.g. hospitalization) or mental health crisis.

Spiritual Advisor (Part 2 of 4)

I would like to have my pastor, priest, rabbi or other spiritual advisor consulted regarding any difficult health care decision that must be made on my behalf. (If no, leave blank)

Do not notify (Part 3 of 4)

I do NOT want the following people notified in case of a medical emergency (e.g hospitalization) or mental health crisis.

Do not visit (Part 4 of 4)

I do NOT want the following people to visit me in case of a medical emergency (e.g, hospitalization) or mental health crisis.

Worksheet Complete

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Next Steps...

This worksheet will help you let your doctors and loved ones know your wishes for mental health care if you have a serious mental health condition.

To include your preferences about the use of life-sustaining treatment in an advance directive.

For guidance about how to talk to your loved ones and health care providers abour your wishes