Statement Of Illinois Law On Advance Directives Page 3
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3State of Illinois
Department of Human Services
STATEMENT OF ILLINOIS LAW ON ADVANCE
DIRECTIVES
1.
Living Will
The Illinois Department of Human Services will not implement living wills within the facility itself. If you have a living will, and if
you should be diagnosed terminally ill or permanently unconscious, you will be transferred to a hospital, hospice, or such other
appropriate location for implementation of this advance directive. Any advance directives (living will or health care power of
attorney) that you sign will become a permanent part of your clinical record at this facility. These documents will be sent to a
general hospital, hospice, or such other appropriate location if conditions exist that would warrant the implementation of a living
will.
2.
Health Care Power of Attorney
In the case of a health care power of attorney, if your condition warrants, your designated agent(s) or successor agent(s) will be
notified of your physical condition, and his/her right to make health care decisions on your behalf, pursuant to the terms of the
health care power of attorney form which you have signed.
I certify that I gave a copy of the Statement of Illinois Law on Advance Directives to the individual (or his/her guardian)
in
English
Spanish
Other (specify language)
at the time of admission. A copy of this statement and any advance directives
the individual may have, have been placed in the individual's clinical record.
Date
Staff Signature
Position Title
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Page 3 of 3
IL 462-0007 (R-1-01)
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