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Comprehensive Guide to DNI Orders and Advance Healthcare Planning
Navigating Do Not Intubate (DNI) decisions is an important part of estate planning for North Tustin residents. A DNI order specifies that a person does not wish to be intubated or placed on mechanical ventilation in the event of severe respiratory failure. Establishing clear advance healthcare directives helps ensure that medical treatment aligns with personal values and minimizes uncertainty for family members and care teams. This guide explains how DNI orders interact with wills, trusts, and powers of attorney under California law and what steps you should take to document and communicate your healthcare preferences effectively.
Many individuals and families in North Tustin find peace of mind by addressing DNI orders within a broader estate planning strategy. Properly documented directives clarify medical choices, reduce conflict during emergency care, and support dignified decision making that reflects a person’s wishes. This page outlines practical considerations for preparing a DNI order, how to coordinate it with other advance directives, and how LA Estate Plans assists clients throughout the process. By planning ahead, you can make sure healthcare providers and loved ones understand and can follow your preferences when you cannot speak for yourself.
Why DNI Orders Matter in Healthcare and Estate Planning
DNI orders play a specific role in conveying treatment preferences regarding intubation and mechanical ventilation. Including a DNI order in your estate plan reduces ambiguity during medical crises, helps avoid unwanted invasive respiratory procedures, and respects your values around life-sustaining treatment. For family members, clear instructions ease the emotional burden of making split-second decisions without guidance. From a legal perspective, a properly executed DNI order that aligns with California requirements increases the likelihood that healthcare teams will honor your wishes and supports coherent planning alongside powers of attorney and advance directives.
About LA Estate Plans and Our North Tustin Practice
LA Estate Plans serves North Tustin and greater Orange County with focused estate planning services that include DNI orders, advance healthcare directives, and related document coordination. Our team provides attentive guidance through each stage of the planning process, from discussing your values and medical preferences to preparing and reviewing legally recognized forms. We emphasize clear communication with clients and practical approaches tailored to local healthcare and legal practice. Our goal is to help residents create enforceable directives that align with California law and with the person’s broader estate plan.
Understanding DNI Orders and How They Work
A Do Not Intubate order is a targeted medical directive that instructs healthcare professionals not to perform intubation or place a patient on mechanical ventilation in the event of respiratory failure. It is distinct from other directives and should be crafted with attention to legal formality, clear language, and coordination with other medical and legal documents. In California, DNI orders are part of a set of advance healthcare planning tools intended to communicate a person’s wishes when they cannot speak for themselves. Knowing how a DNI fits into the larger advance directive framework helps ensure preferences are honored in hospital and emergency settings.
Understanding how DNI orders interact with other documents such as a durable power of attorney for healthcare, living wills, and DNR orders is essential for a cohesive healthcare strategy. A DNI order addresses intubation specifically, while other directives may cover resuscitation, life-sustaining treatment more broadly, or appoint a decision maker. Reviewing and updating these documents periodically helps reflect changing health circumstances or personal values. It is also important to share completed forms with healthcare providers and designated agents so that medical teams have clear, accessible guidance during urgent care situations.
What a DNI Order Is and What It Covers
A DNI order is a medical instruction that indicates a person does not want intubation or mechanical ventilation if breathing becomes compromised. Intubation involves inserting a tube into the airway to support breathing and is commonly used in emergency and critical care. The DNI document communicates a narrow, specific preference and should be recorded on forms recognized by California providers or included within broader advance care planning paperwork. Because medical settings move quickly, concise wording and distribution of the order to treating clinicians help ensure the directive is understood and followed when needed.
Key Steps to Establishing a Valid DNI Order
Establishing a valid DNI order typically involves consulting with your primary care or treating physician, completing the appropriate authorization forms, and ensuring the document meets California signature and witnessing requirements. Coordination with estate planning documents such as powers of attorney for healthcare and living wills ensures consistency across your medical directives. It is advisable to discuss your wishes with loved ones and designated decision makers, keep copies with medical records, and review the order as health or personal circumstances change. Timely communication and proper documentation improve the likelihood that your preferences will be honored.
Glossary: Key Terms for DNI Orders and Advance Directives
Familiarity with common terms used in advance healthcare planning helps you make informed choices and communicate effectively with providers. This section provides clear definitions of terms you will encounter when preparing DNI orders and related documents in California. Understanding these concepts supports better integration of medical preferences into your estate plan and helps ensure that decisions made on your behalf align with your intentions. Use this glossary as a reference while drafting or reviewing your healthcare directives and sharing them with your designated agents and healthcare team.
Do Not Intubate (DNI)
A Do Not Intubate order is a directive expressing that a patient does not want intubation or mechanical ventilation if their breathing fails. This order applies specifically to airway management and respiratory support and should be documented on forms acceptable to California medical providers. A DNI can stand alone or be included alongside other healthcare directives, depending on the person’s preferences. Clear documentation and communication with medical staff and designated decision makers help ensure the order is recognized and followed when clinical situations arise that could otherwise lead to intubation.
Advance Healthcare Directive
An Advance Healthcare Directive is a legal document that outlines an individual’s preferences for medical care if they become unable to make or communicate decisions. It can include a designation of a healthcare agent, instructions about life-sustaining treatments, and preferences for comfort-focused care. In California, advance directives guide clinicians and appointed decision makers in honoring the individual’s wishes. Including a DNI order within or alongside an advance directive helps provide clear, actionable instructions specific to intubation while preserving guidance on other aspects of medical care.
Intubation
Intubation is a medical procedure that involves inserting a tube into the airway to assist or control breathing, often used in emergency or intensive care settings. It is a common intervention for severe respiratory distress but may be contrary to some patients’ wishes, particularly when it would only prolong suffering rather than improve quality of life. A DNI order communicates a refusal of this particular procedure, allowing patients to specify that they do not want mechanical ventilation even if other medical treatments might still be accepted.
Do Not Resuscitate (DNR)
A Do Not Resuscitate order instructs medical personnel not to initiate cardiopulmonary resuscitation (CPR) or other resuscitative measures if a patient’s heart stops or they stop breathing. A DNR is distinct from a DNI, which focuses on avoiding intubation specifically. Both directives can be used separately or together depending on the patient’s wishes. Clear documentation, communication with providers, and coordination with other advance directives ensure that the scope of permitted and forbidden interventions is understood in emergency and inpatient care settings.
Comparing DNI Orders to Other Healthcare Directives
When planning healthcare directives, it is helpful to understand the differences between DNI, DNR, living wills, and powers of attorney for healthcare. A DNI addresses intubation specifically, a DNR addresses resuscitation efforts, a living will can provide broader guidance on life-sustaining treatment preferences, and a healthcare power of attorney appoints a decision maker. Choosing the right combination of documents depends on personal values, medical context, and the desire for broader or narrower instructions. Thoughtful planning helps ensure that documents work together and are enforceable under California law.
When a Focused DNI Order May Be Appropriate:
Preference to Avoid Intubation Only
A person who wishes only to avoid intubation but remains open to other treatments may choose a focused DNI order. This limited approach is suitable for individuals who are primarily concerned about invasive respiratory procedures but who still want other forms of medical care, such as medication or comfort measures. A narrowly tailored DNI clarifies this single preference without restricting broader clinical decisions, which can simplify communication with clinicians and reduce the need for extensive directives when the primary concern is avoidance of mechanical ventilation.
Clarity for Emergency Care Teams
In emergency situations, quick access to a clear instruction can prevent unwanted interventions. A DNI order provides explicit guidance about intubation for paramedics and hospital staff, which can be particularly helpful when decisions must be made rapidly. By labeling the specific intervention to be avoided, the directive reduces ambiguity and helps clinicians act in accordance with the patient’s wishes. Keeping the wording direct and ensuring the order is readily available to treating professionals increases the likelihood that the stated preference is honored during urgent care.
Why a Comprehensive Healthcare Directive Strategy Is Beneficial:
When Multiple Scenarios Must Be Addressed
A comprehensive approach to advance care planning is advisable when a person wants clear guidance covering a range of medical scenarios beyond intubation. Comprehensive planning addresses resuscitation, nutrition and hydration decisions, comfort care preferences, and appointment of a healthcare decision maker. This broader documentation reduces the risk of inconsistent instructions and supports seamless decision making among family and healthcare teams. Integrating DNI orders into a larger set of directives ensures that all treatment preferences are coherent and reflect the person’s overall goals for care.
To Minimize Family Confusion and Disputes
Comprehensive directives help reduce the emotional burden on family members who might otherwise have to interpret a loved one’s preferences during a medical crisis. When clear instructions are available across multiple areas of care, appointed decision makers can act with confidence and healthcare teams have consistent guidance. This can limit disagreements among relatives and support smoother coordination of treatment choices, which is particularly important during stressful situations when prompt decisions are needed. Thoughtful, documented planning fosters clarity and reduces the potential for conflict.
Benefits of Integrating a DNI Order Into a Full Advance Care Plan
Integrating a DNI order into a broader advance care plan provides several advantages, including consistent guidance for medical teams, reduced uncertainty for loved ones, and documentation that aligns various legal instruments. A cohesive plan can address how intubation relates to other life-sustaining treatments and designates who will make decisions if you are unable to do so. Combining a DNI with powers of attorney and living wills ensures that your healthcare values are communicated clearly and can be followed across different care settings and providers throughout California.
Another key benefit of a comprehensive approach is the ability to update and manage all related documents as circumstances change. Periodic review allows adjustments for changes in health status, personal beliefs, or family structure. Centralizing directives and ensuring copies are distributed to designated agents, healthcare providers, and medical records reduces the chance that an individual preference will be overlooked. A well-coordinated plan enhances peace of mind by making intentions explicit and accessible when time and clarity matter most.
Clear Instructions That Travel With You
A comprehensive set of healthcare directives, including a DNI order, can be placed with medical records and shared with hospitals, clinics, and emergency contacts so that your preferences follow you across settings. Having accessible documentation, whether in paper form or stored in a medical portal, increases the likelihood that your choices are recognized during emergency care. Clear, portable instructions prevent inconsistencies and ensure treating clinicians have the necessary information to align care with your articulated values and intentions.
Reduced Burden on Loved Ones
Documenting DNI decisions within a complete advance care plan lightens the emotional load placed on family members who might otherwise face agonizing choices without guidance. When directives are explicit and available, family and appointed decision makers can focus on supporting the patient rather than interpreting intent. This preparation fosters better communication, reduces the likelihood of disputes, and helps ensure medical choices are made in accordance with the person’s wishes, providing clarity and comfort to those tasked with carrying out those decisions.
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Practical Tips for Planning Your DNI Order
Talk With Your Healthcare Provider Early
Begin conversations about a DNI order during routine care or wellness visits so that your medical team understands your preferences before a crisis. Discussing intubation choices with a physician helps clarify medical implications, alternatives, and how a DNI order would be implemented in an emergency. Open dialogue also gives your loved ones and appointed decision maker a clear sense of your values and reasoning. Documenting these conversations and moving forward with signed forms ensures your stated wishes are ready to guide care if needed.
Keep Documents Accessible and Updated
Coordinate DNI Orders With Other Estate Documents
Ensure that your DNI order is consistent with powers of attorney, living wills, trusts, and other estate planning instruments to avoid conflicting instructions during critical moments. Integrated planning supports smoother decision making and legal clarity. Review your estate plan as a set and seek guidance to align medical directives with broader plans for personal and financial affairs. Sharing the coordinated documents with appointed decision makers and healthcare providers helps ensure everyone involved understands the full scope of your wishes.
Reasons to Include a DNI Order in Your Estate Plan
Including a DNI order in your estate plan allows you to express a specific preference about intubation and mechanical ventilation. Many people value the ability to direct the scope of emergency respiratory interventions while preserving other types of care. A DNI order communicates this preference clearly to clinicians and reduces ambiguity in life-threatening situations. For residents of North Tustin, documenting these choices under California law helps ensure medical teams and designated decision makers have the authority and guidance needed to act consistent with your expressed intentions.
Another important reason to consider a DNI order is to relieve loved ones of the burden of making high-stakes medical decisions without guidance. When your wishes are documented, family members and appointed agents can make choices that reflect your values and avoid uncertain disputes. The DNI order also works well with other advance directives and estate planning documents to create a cohesive plan for healthcare decision making. Taking proactive steps to prepare these documents increases the likelihood that your medical preferences will be honored when you cannot speak for yourself.
Common Situations Where a DNI Order May Be Appropriate
People commonly consider a DNI order when faced with life-limiting illness, advanced age, progressive respiratory conditions, or when they personally prefer to avoid invasive airway interventions. Those who anticipate potential ICU care or who have specific wishes about quality of life often incorporate DNI directives into their advance care plans. Planning in advance allows time to reflect on values and to communicate those choices to family and medical teams. Discussing scenarios and outcomes with clinicians helps determine whether a DNI order fits within a broader plan for comfort-oriented or limited medical intervention.
Advanced or Terminal Illness
Individuals with advanced or terminal conditions frequently plan for DNI orders to avoid intubation that would prolong the dying process without improving quality of life. A DNI order can support a focus on comfort measures and symptom control instead of invasive respiratory support. Documenting this preference helps ensure that care aligns with the individual’s values and reduces the potential for unwanted aggressive interventions, which can be particularly important for people nearing the end of life or choosing palliative-focused treatment.
Chronic Respiratory Conditions
Those with chronic respiratory diseases, such as advanced COPD, interstitial lung disease, or other progressive lung conditions, may choose a DNI order to avoid mechanical ventilation that might not improve long-term outcomes. A DNI helps communicate how much intervention the patient desires in the event of respiratory decline. Including such directives in medical records and coordinating with respiratory care teams ensures that preferences are known and considered when treatment decisions are made in clinics or hospitals.
Personal Preference to Avoid Invasive Procedures
Some people, regardless of underlying health, prefer to avoid certain invasive interventions like intubation and mechanical ventilation due to personal beliefs about quality of life and medical treatment. A DNI order allows individuals to express that preference clearly and in a legally recognized way. Communicating these choices with family and medical providers and documenting them alongside other advance directives ensures that care aligns with the person’s values when decisions must be made quickly.
We Are Here to Help North Tustin Residents with DNI Orders
Why Choose LA Estate Plans for Your DNI Order and Advance Care Needs
Choosing a law firm to assist with DNI orders and advance directives is about finding clear communication, reliable document preparation, and practical support for distributing and updating your paperwork. LA Estate Plans focuses on helping North Tustin residents translate healthcare values into properly documented directives that comply with California requirements. We prioritize listening to clients, explaining the legal and medical implications of different choices, and ensuring documents are drafted and executed to be readily used by healthcare providers and designated decision makers.
We emphasize a collaborative process that includes discussion of medical scenarios, review of existing estate planning documents, and careful drafting to avoid contradictions among directives. Our approach includes advising on how to communicate directives to family and medical teams and recommending storage and distribution practices so the orders are available when needed. Practical assistance with signing, witnessing, and record keeping reduces the risk of invalid or inaccessible forms and helps ensure directives are respected.
LA Estate Plans also provides guidance on periodic review and updates to maintain alignment with changes in health or personal circumstances. We help clients incorporate DNI orders into broader estate plans that address financial, personal, and healthcare concerns in a coordinated way. For North Tustin residents seeking clarity and legally sound documentation of medical preferences, our services aim to reduce uncertainty and support confident decision making for you and your loved ones.
Contact LA Estate Plans to Discuss Your DNI Order
How We Handle DNI Orders and Advance Directives
Our process for preparing DNI orders starts with an in-depth conversation to understand your healthcare values and document preferences, followed by drafting the appropriate forms in compliance with California law. We review existing estate planning documents to ensure consistency, assist with proper signing and witnessing, and advise on distribution to healthcare providers and designated decision makers. We also recommend periodic review to keep directives current and help with any necessary revisions as health or personal circumstances evolve.
Step One: Initial Consultation and Planning Discussion
During the initial consultation, we discuss your views on intubation and life-sustaining treatments, review your existing medical and estate documents, and identify who should receive copies of your directive. This meeting is designed to clarify goals, explain the differences among DNI, DNR, and other advance directives, and outline a plan to document and implement your preferences. We make time to answer questions, suggest practical next steps, and determine how to coordinate the DNI order with your broader estate plan.
Discussing Medical Preferences and Values
We begin by exploring your values, experiences, and goals regarding medical interventions to ensure any directives reflect your true intentions. This discussion covers scenarios in which intubation might be considered, the potential outcomes, and alternatives that align with comfort-oriented care or other priorities. Clear communication about preferences helps guide the drafting process and ensures that the resulting DNI order accurately represents the scope of treatment you wish to accept or refuse.
Reviewing Existing Estate and Healthcare Documents
If you already have powers of attorney, living wills, or other estate planning documents, we review them to identify inconsistencies or gaps related to medical decision making. We coordinate the DNI order with these documents so that appointed decision makers and written instructions are aligned. This review reduces the risk of conflicting guidance and supports a cohesive approach that healthcare providers and family members can follow confidently during urgent situations.
Step Two: Drafting and Document Preparation
Once preferences are established, we prepare the necessary forms and language for a DNI order that conforms to California practice. Drafting focuses on clarity and accessibility for medical professionals, while ensuring the document integrates with your durable power of attorney for healthcare and any living will provisions. We then review the drafts with you, explain legal implications, and make any adjustments needed to reflect your values and specific directions regarding intubation and related treatments.
Creating Clear, Actionable Language
The drafting phase emphasizes straightforward language that treating clinicians can quickly interpret during emergencies. We avoid ambiguous terms and craft instructions that clearly delineate whether intubation and mechanical ventilation are to be withheld while leaving other treatments intact as desired. Clear phrasing reduces misunderstandings and helps ensure the DNI order is actionable when time-sensitive decisions are required by medical teams.
Coordinating With Healthcare Agents and Providers
After drafting, we discuss distribution of the DNI order to your primary care physician, specialists, and hospital records and advise on informing the person you appoint to make healthcare decisions. We recommend practical steps for sharing copies and documenting that providers have received the directive. This coordination helps ensure that medical staff and the appointed agent are aware of and prepared to follow the specified preferences in urgent care scenarios.
Step Three: Execution, Distribution, and Ongoing Review
The final step addresses signing, witnessing, and practical distribution of the DNI order. We guide you through the execution process to meet California legal expectations, recommend who should retain copies, and advise how to file the directive in medical records. We also suggest a schedule for periodic review and updating of directives to reflect changes in health or personal preferences so that your documented wishes remain accurate and useful over time.
Signing, Witnessing, and Making the Order Available
Proper execution may include nearby witnesses or notarization as required by medical providers and institutional policies. After signing, we recommend placing copies in your medical record, providing copies to designated decision makers and family members, and keeping a readily accessible original or certified copy. Making the order visible and known reduces the chance that critical instructions will be overlooked during an emergency when quick action is necessary.
Periodic Review and Updates
Health conditions and personal preferences can change over time, so it is important to review DNI orders and related directives periodically. We advise clients on when to update documents, how to communicate revisions to providers and agents, and how to replace older copies in medical records. Regular review preserves the relevance of directives and helps maintain alignment among all estate planning instruments to reflect your current wishes accurately.
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Frequently Asked Questions About DNI Orders
What is a Do Not Intubate (DNI) order and how does it differ from other directives?
A Do Not Intubate order is a medical instruction indicating that a person does not want intubation or mechanical ventilation if they experience respiratory failure. This directive is specific to airway management and does not necessarily cover other life-sustaining treatments. It is distinct from a Do Not Resuscitate order, which addresses whether CPR or advanced cardiac life support should be attempted in the event of cardiac or respiratory arrest. A DNI can be documented as a standalone order or as part of a broader advance healthcare directive. Because a DNI focuses on a particular intervention, it is important to coordinate its language with any living will or durable power of attorney for healthcare. Clear phrasing and placement of the order in medical records help clinicians quickly identify and honor the instruction in urgent situations. Discussing the DNI with your physician and designated decision maker ensures everyone understands its scope and intent, minimizing confusion during emergencies.
How do I establish a valid DNI order in North Tustin and California?
To establish a valid DNI order in North Tustin, begin by discussing your preferences with your healthcare provider and deciding whether the order will be standalone or part of an advance directive. Documentation should follow forms recognized by California providers and comply with institutional signing or witnessing requirements. Ensuring that the order is clear and accessible to treating clinicians is an important part of making it effective in emergency care. It is also advisable to review existing estate planning documents, such as powers of attorney for healthcare, to avoid conflicts. Provide copies to your primary care physician, specialists, designated decision maker, and family members so the order is readily available if needed. Periodic review helps keep the directive aligned with changes in health or personal values.
Can I change or revoke my DNI order after it is signed?
Yes, you can change or revoke your DNI order at any time as long as you have the mental capacity to do so. Revocation typically requires creating a written statement to that effect or signing a new directive that supersedes the previous one. Whenever changes are made, it is important to inform your healthcare providers and designated agent so that the updated directive is recognized and used in place of prior versions. Keeping a clear chain of documentation and distributing updated copies reduces the chance that an outdated order will be followed. It is also helpful to remove or mark older versions as revoked in medical records, and to let family members and decision makers know you have revised your instructions so they can act according to your current wishes.
What should I tell my family and healthcare agent about my DNI order?
Informing family members and the person you appoint as your healthcare agent about your DNI order is an essential part of effective advance care planning. Share the reasoning behind your choice and discuss what scenarios you expect the order to apply to so that those close to you understand your values and can support the decision. Clear communication helps avoid surprises and reduces the emotional burden on loved ones during medical emergencies. Provide copies of the DNI order to your designated agent, family members, and primary care provider so that they can access the document if needed. Encourage conversations with your healthcare team to confirm that the order is documented in your medical record and to clarify how the directive will be implemented in a hospital or emergency setting.
Will a DNI order prevent me from receiving comfort care or other treatments?
A DNI order only addresses the use of intubation and mechanical ventilation and does not automatically preclude other types of medical treatment, such as medications, oxygen therapy, or comfort-focused care. Many people choose DNI orders specifically to avoid intubation while still receiving other appropriate clinical interventions. It is important to state any additional preferences in a living will or advance directive so that the full range of acceptable treatments is clear. Discussing desired approaches to symptom management and comfort care with your medical team ensures that clinicians understand which treatments you wish to accept or refuse. Including detailed instructions in your advance care plan helps preserve both your overall treatment goals and the boundaries you set regarding specific interventions.
Are DNI orders legally recognized in California hospitals and emergency settings?
When properly documented and communicated, DNI orders are recognized by California hospitals and emergency medical personnel as valid expressions of a patient’s wishes regarding intubation. Hospitals and clinics generally follow institutional policies for recording and honoring such directives, and having the order included in your medical record increases the likelihood it will be followed in urgent situations. Clear documentation and distribution to treating providers are key to recognition. Because practices can vary, consulting with your healthcare provider about how they record and use DNI orders can help ensure the directive will be accessible when needed. We also recommend providing copies to your designated healthcare agent and family members so they can present the order or confirm its existence to medical teams during emergencies.
Can family members override a properly executed DNI order?
A properly executed DNI order generally takes precedence over family preferences when it is valid and applicable to the clinical situation. Medical providers are obligated to follow the documented wishes of a capable patient. If disputes arise, having clear, dated documentation and prior conversations with family members and the appointed healthcare agent helps reduce the likelihood of attempts to override the order. Open communication with loved ones about the reasons for your DNI order and sharing copies of the directive can mitigate conflict. If disagreements do occur, hospitals often have processes to review disputes, but the presence of clear written instructions and an appointed decision maker makes it more likely that your wishes will guide care.
What happens if I do not have a DNI order and I am unable to communicate?
Without a DNI order or other clear advance directive, clinicians will generally act in accordance with standard medical protocols to preserve life, which may include intubation and mechanical ventilation during respiratory failure. In the absence of documented preferences, family members or appointed decision makers may be asked to authorize or decline specific interventions, which can create stress and potential conflict during emergency care when decisions must be made quickly. For that reason, creating a DNI order and other advance directives provides clear guidance and reduces uncertainty. Sharing completed documents with healthcare providers and loved ones ensures your preferences are available and can be followed if you become unable to communicate them yourself.
How often should I review or update my DNI order and related directives?
It is recommended to review your DNI order and related advance directives periodically and after significant changes in health, living situation, or personal relationships. Regular review ensures that documents reflect current wishes and medical circumstances. Updates should be documented in writing and shared with healthcare providers, your designated agent, and family members so that everyone is aware of any changes. Additionally, legal or institutional requirements may evolve over time, so occasional consultation with advisors can confirm that your directives remain compliant and practical for use in medical settings. Making updates when needed preserves the effectiveness and relevance of your healthcare plan.
Where should I store my DNI order and who should receive copies?
Store the original DNI order in a safe but accessible place and provide copies to your primary care physician, relevant specialists, and the medical records departments of hospitals where you receive care. Give copies to your appointed healthcare agent, close family members, and any other trusted individuals who may need to present the directive during an emergency. Ensuring multiple copies exist increases the chance the order will be found and followed when needed. Some people also choose to keep a copy with their wallet or medical alert materials or to upload a copy to a secure patient portal or health record system. Communicate clearly where documents are stored so that decision makers and clinicians can quickly access the directive during urgent medical situations.