Privacy & Confidentiality

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Advance Directives & Mental Health Treatment Declaration

As a client of Memorial Behavioral Health, you have the right to express your wishes regarding the level and kinds of care you might wish to receive if you become unable to make these decisions for yourself.

You may choose to express your wishes through advance directives such as a Living Will, a Durable Power of Attorney for Health Care or a Mental Health Treatment Declaration. These documents can document your choices about your future care and, if you choose, name someone to decide for you if you should become unable to speak for yourself.

The following forms are available for download. You will need Adobe Acrobat Reader installed in order to read the downloaded file. If you would like additional information about Advance Directives, please contact the Medical Services Department at 217-525-1064.

If you have a written advance directive, make sure your family and your physician are familiar with it. In addition, each time you are admitted to any medical center or hospital, you should bring a copy with you at the time of registration so that it can be placed in your medical record.

Advance Directive Forms

Memorial Behavioral Health's Advance Directives - This document includes frequently asked questions, a Living Will, and a Power of Attorney for Health Care.

Mental Health Treatment Declaration - This document includes frequently asked questions and a Declaration for Mental Health Treatment form

Illinois Department of Public Health Uniform Do-Not-Resuscitate (DNR) Order Form