Advance Directives Form - Cenpatico Integrated Care AZ 2026

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Click ‘Get Form’ to open the Advance Directives Form in the editor.
Begin with Section I, where you will check and initial the boxes indicating whether you have received written information, a verbal explanation, and the Mental Health Advance Directive Information Guide. Make sure to initial each box accordingly.
If you choose not to have an Advance Directive at this time, please initial that option as well.
Move to Section II, which is filled out by the Clinical Liaison. Confirm if an Advance Directive has been developed by selecting 'Yes' or 'No'. If 'No', inform the recipient that assistance is available.
If an Advance Directive exists but is not filed in the medical record, mark the appropriate box explaining why it is not filed.
Lastly, indicate if the Advance Directive has ever been acted on and ensure all relevant parties have been notified if applicable.

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