Skip to main content

Healthcare Directives

Free downloads and forms are available below and can also be found in English and Spanish on the State of Illinois website.

Forms

We all feel we have the right to make choices about our own healthcare. Most of us will talk with our doctor about pros and cons of different treatment options first. As a competent person, it is our right to agree to or refuse medical treatment. This basic right is protected by law.

But what happens if a serious illness, injury or permanent loss of mental abilities makes us unable to talk to our doctor about medical treatments we do or do not want? At these times, it is hard for all of us as patients, family members, friends, doctors and nurses. Who will make these decisions if we can't do it ourselves? How can we make sure our wishes will be followed? What happens if there are disagreements among those caring for us about treatment options? How will they be settled?

You can answer some of these questions by filling out an advance directive for healthcare. This lets you continue to have a say in your own treatment. An advance directive lets you plan ahead. You can make your wishes known. You can name someone who will see to it your wishes are followed.

CGH Medical Center follows advance directives as long as they meet requirements of Illinois Law. Always bring your advance directive with you when you come to the hospital. They can be copied and attached to your current medical record.

We encourage you and your family to complete an advance directive. You can download these forms right from the bottom of this page. Or contact CGH at 815.625.0400, ext. 5727, or email us for a free and complete advance directive packet. You can also download our chaplaincy brochure.

HIPAA Representative

You can also name a HIPAA Representative who is a person named by a patient that has been granted access to the patient's Protected Health Information (PHI). The HIPAA Representative designation was created in response to requests by patients for a way to document family members or friends who are involved in facilitating the patient's care. For more information on this role, please view our HIPAA Representative FAQ's. If you have other questions, please contact our Main Clinic Business Office at 815.632.5328 or the Hospital's Health Information Department at 815.625.0400, ext. 5566.