Advance Health Care Directives (Living Will)
At your request, Queen's can provide you with an Advance Health Care Directive or Living Will. You may download the "Advance Health Care Directive" form (available in PDF below) to print out and complete. The form must be signed by you in the presence of two witnesses, or notarized. If you have any questions about Advanced Directives or Living Wills, feel free to call Queen's Patient Relations department at 808.691.4602.
There is no charge for physicians and other health care facilities (for direct patient care) if sent directly to a physician or health care facility and requested by them. If a patient requests that information to be sent to the physician or health care facility at the direction of the health provider, it will first be verified before any records are sent.
All other requests are billed directly to the receiver of the medical records (e.g. attorneys, vocational rehabilitation, etc.). For personal and out-of-state requests, fees must be paid in advance.
Advance Health Care Directive Form