Planned Death at Home 2026

1. Click ‘Get Form’ to open the Planned Death at Home document in the editor.
2. Begin with Section 1, where you will enter the patient's name and physician's name. Ensure that both parties understand the health status and prognosis.
3. Designate a substitute decision-maker by filling in their name and relationship to the patient. Both the patient and substitute decision-maker must sign and date this section.
4. In Section 2, confirm that a Do Not Resuscitate (DNR-c) order is completed and ensure family members are aware of whom to contact at the time of death.
5. Proceed to Section 3 to provide funeral home information, including name, address, telephone number, and fax number.
6. In Section 4, indicate where copies of the form will be sent after completion. Make sure to fax copies as required.
7. Finally, complete Section 5 at the time of death with details about pronouncement and notify relevant parties as outlined.

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