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Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

ADRT - Template

Advance Directive to Refuse Treatment - Template

Purpose : Template for the recording of Advance Decision to Refuse Treatment

Admin time :  x min, variable

User Friendly :  High

Administered by : Health care provider or self administered


Content : Record of various decisions detailing situations where the individual wants to refuse medical treatment if unable to make or communicate the decision in the future.

Extensive explanatory notes as to when an Advance Decision would be used and information to help complete the form.


Author :  Original : Compassion in Dying - supporting your Choices, v2.1, 2021

Revised for international use : CGA Toolkit Plus, 2021


Copyright : Free to use with author references

ADRT int'l

This tool is use in Advance Care Planning

Back To : Advance Care Planning

Advance Care Planning, CGA based Proactive Primary Care of the Elderly
doctor and patient

Advance Care Planning is one of 8 domains of the

Comprehensive Geriatric Assessment (CGA)

Back To : Comprehensive Geriatric Assessment

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