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Personal Self-Assessment Scale PSAS - Its OK to Die

Personal Self-Assessment Scale PSAS - Its OK to Die 2025

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The Personal Self-Assessment Scale (PSAS) is a tool designed for individuals to evaluate their mobility, activity level, self-care capabilities, and conscious level in relation to their health status. It allows users to indicate their preferences for medical decisions such as Do Not Resuscitate (DNR), no artificial nutrition, and no intravenous hydration based on their assessed PSAS level. The document emphasizes the importance of keeping this information updated and sharing it with healthcare providers and family members.

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Click ‘Get Form’ to open the Personal Self-Assessment Scale (PSAS) in the editor.
Begin by reviewing the PSAS levels, which are categorized from 0% (Dead) to 100% (Full). Each level describes your mobility, activity level, self-care, and conscious level.
In the green columns under 'Personal Preferences', identify medical decisions you may want to activate at specific PSAS levels. Options include DNR (Do Not Resuscitate), No AN (No artificial nutrition), and No IVH (No IVs for hydration).
For each medical decision you wish to make, place an 'X' in the corresponding column that matches your chosen PSAS level.
Finally, sign and date the document. Ensure it is stored in your living will and shared with your healthcare provider and family members. Remember, you can update this form as needed.

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