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Advance Care Planning Worksheets

Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes. These worksheets can help you reflect on your values, care and treatment preferences, and take steps to prepare your own plan. You can download, print, and copy the worksheets.

Worksheet: Thinking about what matters most when making medical decisions

Reflecting on your values is often the first step in advance care planning. Use this worksheet to think about what matters most to you and how that may affect the kind of medical care you would want. You can pick and choose which questions to review or discuss with your loved ones.

View worksheet (PDF, 655K)

Worksheet: Care and treatment decisions: What would you choose?

Preparing for your care in advance can help you and your loved ones feel more prepared during a medical emergency or at the end of life. Think through these scenarios and the decisions you would make about your care and treatment. Write down your thoughts or discuss with loved ones.

View worksheet (PDF, 647K)

Worksheet: Health care providers to involve in advance care planning

Advance care planning is covered by Medicare as part of your annual wellness visit. Use this worksheet to determine which health care providers you would like to speak with about your advance care plan.

View worksheet (PDF, 653K)

Worksheet: Tips for talking with your doctor about advance care plan

Talking to a health care provider can help you learn about your current health and the kinds of decisions that are likely to come up. Use the tips and conversation starters in this worksheet to help you discuss your advance care plan with a doctor.

View worksheet (PDF, 697K)

Worksheet: Who should I choose as my health care proxy?

A health care proxy is a person who can make health care decisions for you if you are unable to communicate these yourself. Use this worksheet to help you consider who might be a good fit to act as your health care proxy.

View worksheet (PDF, 692K)

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

An official website of the National Institutes of Health