My advance care plan & guide

1 Dec 2016 | Advance Care Planning

My ACPlan and guide 
(3.5MB, pdf)
Electronic My ACPlan (editable) 
(1.8MB, pdf)
How to save my electronic ACPlan 
(312KB, pdf)

These tools will help you think about and write down what matters most to you.

There is no wrong or right way to capture this information. You only need to fill in the bits you want to. If you want to complete Section 6, this is best completed with help from a health care professional.

Once you have captured everything you want, share this with your general practice team and keep a copy with you. You’ll need to take this with you if you go into care or a hospital.

There are two types of advance care plans you can use. The full plan and guide (you can order a hard copy and write into it) or the plan part only (can be printed and written on or completed electronically).

Front cover of the physical advance care plan

My advance care plan & guide (3.5MB, pdf)

This document includes the advance care plan (ACPlan) and guidance on what you might think about or consider as you complete your advance care plan. You will need to fill this out by hand – either print this PDF or order a hard copy by emailing ACP@hqsc.govt.nz and we will send it to you at no charge.

Front page of the electronic advance care plan

My advance care plan (1.8MB, pdf)

Electronic My advance care plan – can be completed electronically or printed and written on. If you fill this out electronically, please save it to your computer/device first. When you are ready to share your ACPlan, you will need to save it as a non-editable PDF by using “PRINT TO PDF” before you email it to others. Download this document (312KB, pdf) or watch this video for instructions on how to do this.

Important: Do not complete the electronic form online in your web browser, it won't allow you to save your completed plan and you will lose your information – always save the form to your computer/device first.

Troubleshooting

If you are having trouble downloading and saving the electronic advance care plan, please check you have the most recent version of Adobe Reader, then download the form and follow the instructions above.

Last updated 20/10/2020