PAD FAQs

• Must have TWO Disinterested Witnesses: Remember, this means they attest to sound mind, free from coercion
• Cannot be revoked orally; must be in writing.
• Do not have to have agent signature if removing agent.
• May revoke at any time (with sound mind!)
• Cannot be Health Care Provider:
  • Physicians and employees, Any licensed, certified, registered or regulated mental health provider,
• Cannot be Health Care Facility
  • Hospital, Hospice, Nursing Facility, Dialysis, HCBS provider, home health care agency, CMHI, other facilities that contracts or provides health care services qualified to provide medical treatment.

• An agent can be instructed, in the PAD, to work with providers to implement instructions and make other decisions as needed.
• Providers can file a petition for commitment and/or to administer medications, but a PAD may also have an effect on what the court decides.
• A person can revoke a PAD.
  • Need 2 disinterested witnesses

• PAD goes into effect upon signatures from all required parties.
• Provider must act in good faith per applicable standards of care; comply with the PAD to the fullest extent possible, consistent with reasonable medical practice, the availability of treatments requested, and applicable law.
• The PAD form shall be complied with unless the adult’s instruction on the PAD form will cause substantial harm to the adult.
  • In that instance, Emergency Medical Service personnel, Health Care Provider, or Health Care Facility shall make a good faith effort to consult with the adult’s agent, if applicable, and offer an alternative course of treatment

You do not have to appoint an agent.  You can make a directive limited to instructions only about your care.  We recommend that you appoint an agent to act on your behalf for all care you are directing.  The appointment of an agent to carry out your wishes means a stronger, more flexible directive, with someone who will work with providers on your behalf at a time when you aren’t doing well. An agent can apply your instructions and wishes to new situations.

•  A health care provider giving you services on the day you sign the document cannot be an agent, unless related to you.  Your agent should not be the owner, operator or employee of a health or residential or community care facility serving you.
• Your case manager should not be an agent due to the potential for conflict of interest between job requirements and following your instructions.
•  Otherwise, your agent can be anyone 18 or older, including family members, partners, and friends.  The person should be someone who uses good judgment and whom you trust to carry out your wishes.

*SOURCED FROM THE MINNESOTA DISABILITY LAW CENTER ADVANCED PSYCHIATRIC DIRECTIVE AND HEALTHCARE DIRECTIVE

• To see that one’s instructions are carried out.
• To work with care providers at a time when it is very hard for the person to do so.
• An agent means a more flexible directive, able to adjust to unforeseen options or circumstances.
• For example, a new medication or a therapy the person did not anticipate in the directive.

• A person 18 years or older who is authorized by an adult to make decisions concerning mental health and substance use disorder treatment, medication and alternative treatment for the adult to the extent authorized by that adult.
• Appointing an agent is not required for a PAD to be in force.
• An agent may be authorized to have total authority to act on the person’s behalf or only those parts of the PAD as outlined in the PAD.
• The agent’s signature must be on the PAD to act as an agent.

• Means an adult, other than a spouse, partner in a civil union, domestic partner, romantic partner, child, parent, sibling, grandchild, grandparent, health care provider, person who at the time of the adult’s signature has a claim against any portion of the adult’s estate at the time of the adult’s death either as a beneficiary of a will that exists at the time of the adult’s signature or as an heir at law.
• Disinterested witnesses attest that the adult executing the psychiatric advance directive was of sound mind and free of coercion when he or she signed the psychiatric advance directive form.

• The most comprehensive and encouraged way to store your pad is at the MTX Website. Start your PAD at the MTX Website here.
• If a person has an agent, it is essential that the agent have a copy.
• Colorado does not yet have a registry for directives, including PADs.
• Person should give his/her PAD to medical/mental health provider; hospital.
• Providers must keep a PAD document in the person’s medical record.
• Some keep their PAD on the refrigerator, so it is handy for emergency personnel.
• Electronically held at attorney’s office
• Cloud storage is with MTX Website.

• Generally, a person is assumed competent – even if committed.
• PAD should not be filled out when a person’s judgment is impaired.
• PAD can be filled out as part of a discharge plan if a person is doing well; has
capacity to make informed decisions.
• Requires signature of two disinterested witnesses.
• Agent does not have to be part of the PAD for discharge to move forward.

• Kids
  • Parents should fill out this Special Power of Attorney form. This protects a parent from losing custody if they were to become involuntarily committed, which could lead to involvement with a child protection case.
    • Designate who you prefer to take care of your kids
    • Must be in accordance with other custody agreements

• Finances
  • Agreement with agent/others to help pay bills and manage finances

• Pets
  • Make prior arrangements, with instructions, plan, and contacts placed in PAD.

• If a person is found gravely disabled or danger to self or others, an involuntary hold takes precedence over the PAD.
• However, provisions of the PAD are still to be honored during the involuntary hold.
• If a person is subject to an involuntary commitment, the PAD is still to be honored during the commitment.

Agent’s:

1. Name, address, and telephone number
2. Scope of authority – Must be either:
   1. Agent is limited to executing the person’s instructions detailed on the PAD form
   2. Agent has authority to make decisions concerning behavioral health treatment, medication, and alternative treatment on behalf of the Adult

1. Person must be of “Sound Mind” and free of coercion.
2. Two disinterested witnesses must attest to such “DecisionMaking Capacity” and to freedom from coercion
3. Must have two disinterested witness, who can attest to sound mind and free of coercion when signing form.
4. Person’s signature or mark & date the person signed the PAD form 2 disinterested witnesses’ signatures or marks and the date that the disinterested witnesses signed the PAD form
5. Agent’s signature or mark and the date the agent signed the PAD form (if applicable)
6. Name, Address, and Telephone number of adult’s Health Care Provider (if applicable)
7. Name of the Health Care Facility in which the adult is enrolled (if applicable)

• Sound Mind – defined in the bill as ”the ability to provide consent to or refusal of behavioral health treatment or the ability to make an informed behavioral health care benefit decision.
• Two Disinterested Witnesses – may not be spouse, partner, family in general, romantic partner, health care facility or provider, or have any interest or expectation in the estate of the person at the time of signing

1. Instructions: A legally recognized document with instructions (directives) on psychiatric care, written in advance of the anticipated need: ‘Now, for later’.
2. Agent: In Colorado a person may name a decision-making agent to carry out instructions.
3. Executed: The PAD is executed by a person (age 18 or older) with sound mind to do so in writing, signed and dated, by two witnesses.

1. When to treat/hospitalize
   • For example: I authorize my agent to get me behavioral health help if I start to… if I start hearing voices telling me to hurt myself…
2. Alternatives to hospitals
   • For example: I prefer to go to a crisis bed, not a hospital if I am feeling self-destructive.
3. Knowledge of medication effects
   • For example: I will take this antipsychotic but have learned from past experience not to have a dosage over XYZ
4. Adverse actions
   • For example: I do not want injections because I am afraid of shots but I am OK with pills.
5. Trauma concerns
   • For example: Because of past trauma, I cannot be put into restraints. This would worsen my condition. Please do this instead…
6. Setting treatment parameters for providers and agents
   • For example: I authorize my agent/provider to treat with the anti-psychotics they decide on, but if I start exhibiting the following side effects, I want the medication reduced or stopped. Could also list allergies to medication

CAVEAT: A PAD is not a wish list.
It does not give a person more rights or services than they are reasonably and otherwise entitled to as any other person.

The PAD form must contain the following:

• Name, date of birth, and gender
• Eye color and hair color
• Race or ethnic background
• Instructions concerning behavioral health treatment
• Instructions concerning medication
• Including primary and alternative instructions
• Instructions concerning alternative treatment
• Instructions concerning appointing agent or not appointing an agent
• If the person decides to appoint an agent, they must include the agent’s information. Click here to view what information is required.