Creating Your Own PAD Form

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 […]

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,

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

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

Agent’s: 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

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