VA Form 10-0137A Your Rights Regarding Advance Directives

VA Form 10-0137A or the "Your Rights Regarding Advance Directives" is a form issued by the United States Department of Veterans Affairs.

The form was last revised on September 1, 2011 - an up-to-date fillable PDF VA Form 10-0137A down below or find it on the Veterans Affairs Forms website.

ADVERTISEMENT
YOUR RIGHTS REGARDING ADVANCE DIRECTIVES
Advance Directives. Advance directives are legal forms that state your preferences about
your future medical and mental health care. If you become too ill to make decisions about
your care, an advance directive can help your doctors and family members understand what
you want.
It is up to you to decide if you want an advance directive. Your decision will not affect
your access to health care or other VHA services.
There are two types of advance directives. In the Department of Veterans Affairs
(VA), the two types are in one form. You may complete neither, one, or both of the
following:
Durable Power of Attorney for Health Care. In this type of advance directive, you name a
person as your Health Care Agent who is to make health care decisions for you if you are not
able to do so. Your Health Care Agent is the first person your health care team contacts for
decisions about your care.
Living Will. In this type of advance directive, you state your preferences about treatments
you want, or don't want, in different situations when you cannot make treatment decisions
yourself. A living will helps your Health Care Agent or others know what treatments you
would choose.
Your Rights:
1. You have the right to accept or refuse any medical treatment.
2. You have the right to complete a durable power of attorney for health care.
3. You have the right to complete a living will.
Your Responsibilities:
1. If you have an advance directive, it's important to give the Veterans Health Administration
(VHA) a copy for your health record.
2. If you'd like more information about advance directives, or help filling out the forms,
please call
to schedule an appointment.
VA FORM
10-0137A
SEP 2011
YOUR RIGHTS REGARDING ADVANCE DIRECTIVES
Advance Directives. Advance directives are legal forms that state your preferences about
your future medical and mental health care. If you become too ill to make decisions about
your care, an advance directive can help your doctors and family members understand what
you want.
It is up to you to decide if you want an advance directive. Your decision will not affect
your access to health care or other VHA services.
There are two types of advance directives. In the Department of Veterans Affairs
(VA), the two types are in one form. You may complete neither, one, or both of the
following:
Durable Power of Attorney for Health Care. In this type of advance directive, you name a
person as your Health Care Agent who is to make health care decisions for you if you are not
able to do so. Your Health Care Agent is the first person your health care team contacts for
decisions about your care.
Living Will. In this type of advance directive, you state your preferences about treatments
you want, or don't want, in different situations when you cannot make treatment decisions
yourself. A living will helps your Health Care Agent or others know what treatments you
would choose.
Your Rights:
1. You have the right to accept or refuse any medical treatment.
2. You have the right to complete a durable power of attorney for health care.
3. You have the right to complete a living will.
Your Responsibilities:
1. If you have an advance directive, it's important to give the Veterans Health Administration
(VHA) a copy for your health record.
2. If you'd like more information about advance directives, or help filling out the forms,
please call
to schedule an appointment.
VA FORM
10-0137A
SEP 2011

Download VA Form 10-0137A Your Rights Regarding Advance Directives

1422 times
Rate
4.6(4.6 / 5) 71 votes
ADVERTISEMENT