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Learning Check: Advance Directive Protocol
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Learning Check
Check your understanding. Choose the best answer for each multiple choice question, then respond to the open response questions in your own words. Review the answer key at the end.
1. A patient's Intake Form shows no Advance Directive on file. Which is the best way to get ready for the visit?
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A
Bring the protocol form and the Short Form, since it is quicker to finish in one visit
B
Bring the protocol form and a blank Long Form, and ask the patient to find two witnesses before you arrive
C
Bring the protocol form, the It's Hard to Think About handout, a blank Advance Directive, and a wallet card. Know how signing works in your clinic and identify a notary if needed.
D
Bring the protocol form and the Dementia Directive, since it covers what the patient wants for the future
2. Mrs. Ortega has finished the Long Form with your help. What is the best next step?
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A
Have her sign now so the form is complete, then ask a notary to review it later
B
Have her sign now in front of two witnesses, such as her daughter and yourself
C
Leave the form with her to have it witnessed or notarized, and check back next month
D
Do not have her sign yet. Arrange a time with the notary, and set a later visit to sign in front of them.
3. Mrs. Ortega signed her Advance Directive in front of a notary. Which steps do you complete? (Check all that apply.)
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Confirm she has the original at home
Give her an Advance Directive wallet card
Make a copy, submit it to be scanned in the EHR, and return the original to her
Alert the PCP that an Advance Directive has been completed
Keep the original in the clinic file
4. A patient says she is not ready to complete an Advance Directive. What do you do?
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A
Respect her decision and do not bring it up again unless she does
B
Document that she did not want to complete one at this time and set a reminder to revisit in 30 days. With her consent, offer to schedule an Advance Care Planning appointment with the PCP.
C
Document her decision and set a reminder to revisit at her next annual visit
D
Document her decision and schedule an Advance Care Planning appointment with the PCP, since the PCP can explain it better
5. In your own words, how would you respond to a patient who says, “I'm not ready for that”?
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6. What, if anything, are you still wondering about?
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Feedback
7. Did you run into any technical issues completing this module (broken links, loading, navigation problems)?
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A
No issues
B
A few minor hiccups
C
Yes, something was frustrating or broken
8. Was anything confusing, missing, or worth adding?
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Submit
