Creating Your Own PAD Form
- Name, address, and telephone number
- Scope of authority – Must be either:
- Agent is limited to executing the person’s instructions detailed on the PAD form
- Agent has authority to make decisions concerning behavioral health treatment, medication, and alternative treatment on behalf of the Adult
- Person must be of “Sound Mind” and free of coercion.
- Two disinterested witnesses must attest to such “DecisionMaking Capacity” and to freedom from coercion
- Must have two disinterested witness, who can attest to sound mind and free of coercion when signing form.
- 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
- Agent’s signature or mark and the date the agent signed the PAD form (if applicable)
- Name, Address, and Telephone number of adult’s Health Care Provider (if applicable)
- 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
- Instructions: A legally recognized document with instructions (directives) on psychiatric care, written in advance of the anticipated need: ‘Now, for later’.
- Agent: In Colorado a person may name a decision-making agent to carry out instructions.
- 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.
- 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…
- Alternatives to hospitals
- For example: I prefer to go to a crisis bed, not a hospital if I am feeling self-destructive.
- Knowledge of medication effects
- For example: I will take this antipsychotic but have learned from past experience not to have a dosage over XYZ
- Adverse actions
- For example: I do not want injections because I am afraid of shots but I am OK with pills.
- Trauma concerns
- For example: Because of past trauma, I cannot be put into restraints. This would worsen my condition. Please do this instead…
- 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.