Fillable Printable VA Form 10-0137A

VA Form 10-0137A

YOUR RIGHTS REGARDING ADVANCE DIRECTIVES

Advance Directives. Advance directives are legal forms that state your preferences about

your future medical and mental health care. If you become too ill to make decisions about

your care, an advance directive can help your doctors and family members understand what

you want.

It is up to you to decide if you want an advance directive. Your decision will not affect

your access to health care or other VHA services.

There are two types of advance directives. In the Department of Veterans Affairs

(VA), the two types are in one form. You may complete neither, one, or both of the

following:

Durable Power of Attorney for Health Care. In this type of advance directive, you name a

person as your Health Care Agent who is to make health care decisions for you if you are not

able to do so. Your Health Care Agent is the first person your health care team contacts for

decisions about your care.

Living Will. In this type of advance directive, you state your preferences about treatments

you want, or don't want, in different situations when you cannot make treatment decisions

yourself. A living will helps your Health Care Agent or others know what treatments you

would choose.

Your Rights:

1. You have the right to accept or refuse any medical treatment.

2. You have the right to complete a durable power of attorney for health care.

3. You have the right to complete a living will.

Your Responsibilities:

1. If you have an advance directive, it's important to give the Veterans Health Administration

(VHA) a copy for your health record.

2. If you'd like more information about advance directives, or help filling out the forms,

please call to schedule an appointment.

VA FORM

SEP 2011

10-0137A