Advance Directives Policy



Advance Directives

Original Date

Review Dates

Revision Dates





It is the policy of Spivey Station Surgery Center (SSSC) to honor a patient’s right to execute a written Advance Directive in accordance with The Georgia Advance Directive for Health Care Act (O.C.G.A. Title 31 Chapter 32) effective July 2007. Spivey Station Surgery Center encourages patients to create Advance Directives and has available information about how to execute an Advance Directive. The patients who are scheduled for surgery at Spivey Station Surgery Center are presumed to be capable of undergoing the necessary anesthesia and surgical procedure that is performed at the Surgery Center.  Given the parameters that we use and the expected outcome of a successfully completed operative procedure, all-reasonable efforts will be made to resuscitate every patient at Spivey Station Surgery Center regardless of the statement in his/her Living Will or Advance Directives. As soon as practical, after resuscitating the patient and transferring the patient to a more appropriate health care facility, the stipulations of the Advance Directives will be respected and carried out.


A. Agent – A person appointed to make medical decision for someone else, as in a Durable Power of Attorney for Health Care (also called a surrogate or proxy).

B. Attending Physician – The physician selected by or assigned to a patient who has primary responsibility for the treatment and care of the patient. When more than one physician shares such responsibility, any such physician may act as the attending physician.
C. Advance Directive – A document in which a person either states choices for medical treatment or designates who should make treatment choices if the person should lose decision-making capacity. Examples of these documents are a Living Will and Durable Power of Attorney for Health Care.

D. Decision-Making Capacity – The ability to make choices that reflect an understanding and appreciation of the nature and consequences of one’s actions and the patient has not been declared incapacitated by any court nor has a guardian been appointed over his or her person.
E. Declaration – An Advance Directive.

F. Durable Power of Attorney for Health Care (DPAHC) – An Advance Directive in which an individual names someone else (the “agent” or “proxy”) to make health care decisions in the event the individual becomes unable to make them himself or herself. The DPAHC can also include instructions about specific healthcare choices to be made.
G. Living Will – A written document executed by the patient directing that should the patient have a terminal condition, life-sustaining procedures will be withheld or withdrawn.

H. Directive for Final Healthcare – A written document executed by the patient which combines the Durable Power of Attorney for Health Care and Living Will documents.


1. In the preoperative telephone interview, if a patients has an Advance Directive, they will be asked to bring their Advance Directive to the to the surgery center the day of surgery.  Patient’s acknowledgement of an Advanced Directive will be documented in the telephone pre-assessment form.
2. If during the interview process a patient verifies that he/she has an Advance Directive the patient will be informed of Spivey Station Surgery Center’s policy to make every effort to resuscitate.
3. In advance of the date of the procedure the patient will be provided with SSSC’s the policy on Advance Directive including a description of applicable state health and safety laws and if requested official state Advance Directive forms.
4. Patient will complete the Patient Consent to Resuscitative Measures at the time of Pre-registration and a copy will be placed on the chart and will be given the patient.
5. If it is necessary to resuscitate the patient he/she will be transferred to a more appropriate health care facility as soon as possible and the receiving facility will be notified of the patient’s Advance Directive.


Attachment A – Patient Consent To Resuscitative Measures

Attachment B – Georgia Law Advance Directive for Healthcare

Attachment C- Georgia Advanced Directive for Healthcare Form



Perioperative Clinician


Spivey Station Surgery Center Administrator:  Vangie Dennis RN, BSN, CNOR, CMLSO
Medical Director Spivey Station Surgery Center:  Stephen Cohen MD
Senior Vice President of Strategic Development and Planning: Jim Crissey
Board Approval