Deciding Right - Advance care planning forms

These forms help you record your wishes and preferences about future care and treatment, so healthcare professionals and those close to you know what matters to you and how you would like to be cared for if you become unwell or cannot communicate.

The Deciding Right forms are colour coded to ensure they are easily recognisable, particularly in an emergency. Colour printing is the gold standard and should be used wherever possible. Where access to a colour printer is not available, black and white forms, including DNACPR forms, will be accepted by all healthcare settings.

Print-ready versions (PDF)

Print blank copies of these forms to complete by hand, or use these forms if you do not have access to Microsoft Word.

Advance Decision to Refuse Treatment (ADRT)

This form lets you say which medical treatments you do not want in the future if you cannot speak for yourself. If it is valid, it is legally binding and must be followed. It is for adults who want to formally refuse specific treatments.

Advance Statement (AS)

This form records what matters to you, such as your wishes, beliefs, and care preferences. It is not legally binding, but it helps guide staff and loved ones if you cannot communicate. It is for anyone who wants their preferences known.

Do Not Attempt CPR (DNACPR)

This form says that CPR should not be attempted if your heart and breathing stop. It does not stop other treatments. It is for people where CPR would not work or is not wanted.

Emergency Healthcare Plan (EHCP)

This plan explains what should happen in a medical emergency, based on your wishes. It is not legally binding but guides professionals and carers. It is for people at risk of sudden illness or deterioration.

Treatment Escalation Plan (TEP)

This plan sets out what treatments should be considered if your condition gets worse. It helps guide decisions about hospital care and levels of treatment. It is for people with serious or ongoing health conditions.

Special Patient Note (SPN)

NEAS can apply a flag to the patients records to notify the Health Advisor (HA) of any information contained in the SPN when handling a 999 or 111 call. Once this flag is accepted this vital information could be used to support the HA to ensure the most appropriate disposition is reached. If a crew attends the case or a clinician is asked to call the patient back they will also be able to see this flag.

Mental Capacity Assessment (MCA)

This form must be completed by a healthcare professional. MCA1 is not needed for babies and young children or for minor decisions (eg. washing). For other individuals and for any key care decision, complete MCA1 if there is an indication of an impairment or disturbance of the individual’s mind or brain.

Type-in word versions (DOCX)

These forms can be completed and edited using the Microsoft Word desktop app for more flexibility and control.

Advance Decision to Refuse Treatment (ADRT)