Psychiatric Advance Directive (PAD) Crisis Plan* 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information, including your name, date of birth, phone number, and address at the top of the form.
  3. In the Activation section, select and initial one statement that reflects your wishes regarding decision-making during incapacity.
  4. For modifying or revoking your PAD plan, choose and initial one of the provided statements to indicate your preferences.
  5. If you wish to appoint a mental health care representative, fill in their details. If not, simply indicate that you do not wish to appoint anyone.
  6. Complete sections A and B regarding the authority of your representative if applicable. Initial your choices accordingly.
  7. Detail your wishes for mental health treatment during a crisis in Part 1 and Part 2. Specify symptoms that indicate a crisis.
  8. List any medical information, medications, and treatments that are relevant in Part 4 through Part 9.
  9. Finally, sign and date the document at the end. Ensure it is witnessed as required by law.

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I, (your name) , being of sound mind, willfully and voluntarily execute this health care advance directive to assure that, during periods of incapacity or incompetency resulting from psychiatric or physical illness, my choices regarding my mental health care will be carried out
I do not want my life to be prolonged if the likely risks and burdens of treatment would outweigh the expected benefits, or if I become unconscious and, to a realistic degree of medical certainty, I will not regain consciousness, or if I have an incurable and irreversible condition that will result in my death in a
Usually, you cant force someone to go to therapy or get psychiatric treatment. However, if you believe that your loved one may be a danger to himself or to others because of a mental condition, in California, for example, you may want to consider a 5150 hold.
A PAD is a legal document in which patients can describe the types of mental health treatments that they would or would not be willing to receive. Patients can also use a PAD to appoint an authorized decisionmaker, or agent, to make mental health treatment decisions on their behalf.
A psychiatric advance directive (PAD) is a legal document that documents a persons preferences for future mental health treatment, and allows appointment of a health proxy to interpret those preferences during a crisis.

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A PAD is a legal document that details a persons preferences for future mental health treatment or names an individual to make treatment decisions if the person is in a crisis and unable to make decisions.
PART V: SIGNATURE AND SEAL OF NOTARY PUBLIC (Optional) This VA Advance Directive form is valid in VA facilities without being notarized.

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