PatientAdvanceDirective

Legal documents expressing a patient's healthcare preferences when they are unable to communicate or make decisions. Covers living wills, DNR orders, healthcare proxy designations, and organ donation wishes.

Overview

PatientAdvanceDirective captures legally binding documents that guide healthcare decisions when patients cannot speak for themselves. These directives are critical for emergency situations, end-of-life care, and ensuring patient autonomy is respected. The entity tracks the directive type, designated decision-makers, specific instructions, and verification by healthcare providers.

Key Concepts

Directive Types

The directiveType field categorizes the advance directive:

End-of-Life Directives

• living-will - Instructions for treatment if terminally ill or permanently unconscious
• dnr - Do Not Resuscitate order refusing CPR
• polst - Physician Orders for Life-Sustaining Treatment (portable medical order)

Decision-Maker Designations

• healthcare-proxy - Designates a person to make healthcare decisions

Specific Wishes

• mental-health - Psychiatric advance directive for mental health treatment
• organ-donation - Wishes regarding organ and tissue donation
• other - Other advance directive types

Healthcare Proxy System

Patients can designate decision-makers through:

• healthcareProxy - Primary person via Person authorized to make healthcare decisions
• alternateProxies - Backup decision-makers if primary proxy is unavailable

The proxy hierarchy ensures someone is always available to make decisions when the patient cannot.

Document Timeline

Key Dates

• documentDate - When the directive was signed/created
• effectiveDate - When the directive becomes active (often same as document date)
• expirationDate - Optional expiration for directives with limited duration

Verification Process

Healthcare providers verify directives to ensure authenticity:

• verifiedBy - Practitioner who confirmed the directive
• verifiedDate - Date of verification
• documents - Scanned copies of signed legal documents via Document

Directive Status

The status field tracks the current validity:

Use Cases

Emergency Room Admission

When an unconscious patient arrives:

1. Query active advance directives for the patient
2. Check directiveType for DNR or living-will
3. Review instructions for specific treatment wishes
4. Contact healthcareProxy for additional decisions
5. Document that directive was followed

End-of-Life Care Planning

During palliative care discussions:

1. Review existing directives with patient and family
2. Create or update directives based on patient wishes
3. Designate healthcare proxy and alternates
4. Have directive verified by attending physician
5. Ensure documents are accessible to care team

Organ Donation Coordination

When patient has organ donation directive:

1. Identify patients with directiveType: "organ-donation"
2. Contact organ procurement organization
3. Coordinate with family and healthcare proxy
4. Honor specific instructions about organs/tissues

Directive Renewal

For directives approaching expiration:

1. Query directives where expirationDate is approaching
2. Notify patient to review and renew
3. Mark old directive as superseded when replaced
4. Create new directive with updated documentDate

Related Entities

Enums

directiveType

status