Registering an Advance Directive

The Vermont Advance Directive Registry is an electronic database that stores advance directive documents. You are not required by law to send an advance directive to the registry. However, registered directives will allow hospitals or other providers to have quick access to these documents in an emergency.

Chart - Number of Advance Directive registrations. Click for full size pdfRegistration is free for Vermonters.

How to Register an Advance Directive

Here are the forms and instructions to create and register an advance directive, and to register one you may already have.

IMPORTANT: You must also send in a Registration Agreement Form.
person signing a document

1. Print out the Forms

Fill out the forms and sign the Registration Agreement.
With the Registration Agreement, you give the registry permission to send a copy of your advance directive and emergency contact information to those authorized to access them.

2. Mail or Fax the Advance Directive and Agreement

Mail or fax the Advance Directive, along with a completed and signed Registration Agreement to:

Vermont Advance Directive Registry
523 Westfield Ave.
PO Box2789
Westfield, NJ 07091-2789
 
Fax: 908-654-1919

If you DO NOT want your Advance Directive in the Registry

Use an Advance Directive Locator Form if you have privacy concerns about registering your detailed advance directive.

What is a Locator Form?
The Locator Form is stored in the registry in place of the actual advance directive. It describes the physical location of your advance directive and who has copies, but does not detail its contents.

IMPORTANT: Using the Locator Form may delay important health care decisions until the advance directive document is retrieved.

Mail or Fax the Locator Form and the Registration Agreement

Send the Locator form with a completed and signed Registration Agreement to:

Vermont Advance Directive Registry
523 Westfield Ave.
P.O. 2789
Westfield, N.J. 07091-2789

Or Fax to: 908-654-1919

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Forms

Registration Agreement Form
The Registration Agreement authorizes the registry to send a copy of your advance directive and emergency contact information to those authorized to have access.

Locator Form
The Locator Form takes the place of the advance directive in the registry. It describes the physical location of your advance directive and who has copies of it -- but does not detail the actual contents.

Advance Directive Forms

You may use any of the forms either from the organizations listed below, or from another of your choice. Vermont law does not favor one form over another.

Vermont Department of Health - Long form, nine sections:

Vermont Ethics Network
Offers both Short and Long forms, and an Advance Directives checklist.

Vermont Protection & Advocacy
This form may be used if you wish to include additional directions regarding psychiatric treatment and medications.

Vermont Department of Disabilities, Aging & Independent Living
This form may be used for people with developmental disabilities who want to appoint a health care agent, but may not be able to describe detailed advance directives.

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Confirmation from the Registry

The Registry will mail you a confirmation letter that the documents were scanned and safely stored in the registry.

You will receive:

Each year, the Vermont Advance Directive Registry will contact you by mail to confirm your advance directive information.

You are responsible for the accuracy of your advance directive, to ensure it reflects your wishes and instructions at all times, and any other important update information such as changes of address for your agent and alternate agents.

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