/depts/,/depts/uwhealth/,/depts/uwhealth/him/,/depts/uwhealth/him/amd/,

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UWHC,UWMF,

Medical Records,

Departments & Programs,UW Health,Health Information Management

Advance Medical Directives (AMD)

Advance Medical Directives (AMD) - Departments & Programs, UW Health, Health Information Management

Focus

UW Health HIM maintains the process for management of all advance medical directives and legal documents for UWHC, UWMF, ACHC, and UWH affiliates. Documents include:

All documents are processed during normal business hours within 24 hours of receipt in HIM. Once approved, the documents are scanned into the EHR and viewable under the Media tab. An FYI flag is entered in Health Link (as appropriate). Documents not accepted (not valid) are returned to the appropriate person with a letter explaining the reason for rejection.  The letter is retained in the Letters Tab in Health Link.

Documents collected in patient care settings can be forwarded to HIM the following ways:

FAQ

A physician has declared a patient as incapacitated and not able to effectively make medical decisions (completed an Incapacity Statement) and there is no POAHC form on file, what should I do?

An Incapacity Statement without a POAHC on file is of no value. Please make sure to obtain a copy of a POAHC and submit to HIM. HIM cannot accept the Incapacity Statement without a POAHC.

Are Emergency Detention documents maintained in the medical record? What should I do with them?

Yes, they are maintained in Health Link. Send these documents to HIM for review/scanning.

Can a legal guardian or designated health care agent for an incapacitated patient sign a DNR form?

Yes, as long as the appropriate documents are on file.

Can a patient submit address changes without having to complete an entirely new POAHC?

Yes – change of address should be submitted in writing to HIM. HIM will scan the change to the original POAHC

Can I be a witness on a POA document?

No, employees of UW Health may not be a witness unless they hold a position of Clergy or Social Work. This is in compliance with Wisconsin state law.

Do we accept out of state Advance Medical Directives?

Yes. We will accept out of state AMDs knowing that state regulations vary. Please review to make sure the document is complete prior to submitting to HIM for review/approval/scanning.

How does a patient revoke a POAHC? Do they need to submit a new one?

The patient can revoke a POAHC in a number of ways. It is recommended that this be done in writing either by submitting a new POAHC (automatically voids the original), submitting a letter indicating the POAHC is revoked or by sending a copy of the POAHC with the words “REVOKED” across it with the patient’s signature and date of revocation.

How is a new POAHC handled when one is already on file?

The patient can revoke a POAHC in a number of ways. It is recommended that this be done in writing either by submitting a new POAHC (automatically voids the original), submitting a letter indicating the POAHC is revoked or by sending a copy of the POAHC with the words “REVOKED” across it with the patient’s signature and date of revocation.

Is an Out of Hospital DNR form valid with just a physician signature or does it require both the patient and the physician to sign?

No – physician signature alone is not valid. The form requires both the patient and the physician signature. If a form signed by just one is submitted to HIM, it will be returned it to the provider.

Is it OK to accept a POAHC if the Anatomical Gift section is not completed?

Yes, this section is optional.

Is it required that there be two witnesses on a Power of Attorney for Health Care?

State of Wisconsin has clear definitions of whom and how many witnesses are required on a Power of Attorney for Health Care. These witnesses must be over the age of 18 and cannot be related by blood, marriage or adoption, or be directly financially responsible for the patient’s health care.

Is there a timeframe in which the two physicians must sign an Incapacity Statement?

According to state law, this should be done at the same time. HIM cannot accept Incapacity Statements signed by physicians where there is a discrepancy in the timeframe in which the document was signed.

Is there any type of review of the document that I need to do prior to sending to HIM?

If patient is still in-house, Social Workers are to review and approve content. When this has been done, they are to initial and date the lower corner of the document – HIM will not re-review if initialed by Social Work and will automatically accept and scan into Health Link. 

Otherwise, review the document to ensure all elements have been addressed as well as appropriate signatures/dates have been obtained before sending to HIM for review/scanning. HIM will perform a final review of these documents prior to accepting/scanning into Health Link.

Should I do anything if the dates on a POAHC do not match (witness date does not match the patient’s signature date)?

UW Health will accept these documents, however other organizations may not – WI statutes require that the witness date and the patient signature date match. Please review with the patient and recommend that a new document be completed if such discrepancies exist.

What do I do if I see an error in an AMD that has been scanned into Health Link?

Contact HIM Advance Directive staff at (608) 263-6030, Option 3.

What if some information is missing from a Power of Attorney for Health Care, can I still accept it?

Please review all aspects of the document prior to accepting – this document declares a patient’s wishes. Some elements of the document, if missing, will result in rejection of the document. It is best to review and complete all sections prior to submitting to HIM for review/approval/scanning.

What is a Durable Power of Attorney and what should I do with it if I get one from a patient?

A Durable Power of Attorney is a document addressing the patient’s financial status and estate. If this document is provided by the patient, the original should be given back to the patient with a copy sent over to Patient Billing Services.

What is the difference between an Advance Directive/Advance Medical Directive (AMD) and a POAHC?

An Advance Directive (or Advanced Medical Directive) is a general term used to define Power of Attorney for Health Care, Living Will, Declaration to Physicians, Five Wishes, or any other document that informs health care providers of a patient’s wishes and desires relating to their care. This is oftentimes confused with a Power of Attorney for Health Care (POAHC).

What is the process when I receive a copy of an Advance Directive – where do I send this to get it filed into Health Link?

Inpatient – Always give the original document back to the patient. A copy should be maintained in the brown chart until the patient is discharged. Tube a copy of the document the Coordinated Care Office at Tube #661 (or deliver to E5/620). They will immediately scan and e-mail documents to HIM for processing. 

Ambulatory – Always give the original document back to the patient. A copy should be sent to HIM for review/approval/scanning. This can be done by multiple methods:

What should I do if is see a document scanned and there is no FYI flag in the system?

UWMF scanned AMDs prior to the FYI flag implementation. There may be a low volume of those AMDs that do not have an FYI flag. If one is identified, contact HIM at (608) 263-6030, Option 3 and the staff will update appropriately.

What should I do with any legal or court documents?

Send to HIM for review and determination as to what gets scanned into Health Link.

Where can I find a copy of any Advance Directive documents?

Check Health Link first – Consent/Legal Tab or Media Tab. Older documents are maintained in the paper medical record.

Who enters FYI flags for Advance Directives?

Health Information Management (HIM) staff should be the only people who enter FYI flags for any Advance Directives or legal documents. This ensures that the FYI flag accurately defines the status of the AMD or legal document and it is legally acceptable.

Resources

Medical Records

Authorizations/Advance Directives