This form can be used to:

  • Appoint an agent,
  • Show which powers you want to give your agent,
  • Write brief health care instructions,
  • Write instructions about end-of-life care, and
  • Write instructions about organ donation.

This form was developed by legal and health care experts to be simpler and easier to use than the HCDA Form.  Like the Integrated Form, the VHHA form provides more guidance and flexibility in helping you give directions about health care.

However, the VHHA Form does not have specific sections about health care history and needs related to mental health crisis. It also does not have the protest provision.

You can download a PDF of the VHHA Form by clicking here.

The Virginia Hospital & Healthcare Association (VHHA) Form