Swiss Advance Healthcare Directive

Advance Healthcare Directive

1. Personal Information
First name / Last name: [[FIRST_NAME_1]] [[LAST_NAME_1]]
Date of birth: [[DATE_OF_BIRTH_1]]
Address: [[ADDRESS_1]]

2. Purpose of this Advance Healthcare Directive
This advance healthcare directive applies if I am no longer capable of making decisions and can no longer make medical decisions for myself.
With this document, I:
• set out my wishes regarding medical treatment
• appoint a representative
• may appoint an alternate representative

3. Representative
I appoint the following person as my representative for medical decisions:
First name / Last name: [[FIRST_NAME_2]] [[LAST_NAME_2]]
Date of birth: [[DATE_OF_BIRTH_2]]
Address: [[ADDRESS_2]]
Telephone: [[TELEPHONE_1]]
Email: [[EMAIL_1]]
My representative may speak with doctors, hospitals, care institutions, and other medical professionals and make decisions on my behalf if I am no longer able to do so myself.
They shall decide according to my wishes and in my best interests.