National Healthcare Decisions Day 2020 - Vermont Participant Form

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Thank you for your interest in joining our statewide effort to spread awareness of the importance of advance care planning on National Healthcare Decisions Day 2020 (April 16). Please share your organization's plans on this date (or the surrounding week of April 12-18) via the form below.

Questions? Please contact sbrown@vtethicsnetwork.org.

Your Name: *

Organization/Facility Name: *

Event(s) Planned (please be as specific as possible): *

Date of Event(s): *

Time of Event(s): *

Resources Needed (please check which materials you anticipate needing to order beforehand; we will be in touch directly regarding quantities and billing):

Advance Care Planning Overview Brochures

Appointment of a Health Care Agent Brochures (Step 1)

Appointment of a Health Care Agent Forms

Complete Guide to Medical Decision Making Booklets (Step 2)

Advance Directive Short Forms

DNR/COLST Brochures (Step 3)

Other:

Do we have your permission to promote the event(s) listed above in an upcoming press release, on the Vermont Ethics Network website, etc.? *

Yes

Is there anything else you'd like us to know?

Submit

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