Are you completing this order for your future self, or reflecting on the experience of someone else? Please select one option Myself Someone else Main doctor managing medical care: Please select one option Family doctor Specialist doctor, as applicable to condition Palliative care doctor Not sure, please recommend Main location to receive care: Please select one option Emergency department Hospital Palliative care unit in hospital Doctor's office Long-term care facility Home, with home care Home, without home care Hospice Not sure, please recommend Location of death: Please select one option Hospital Palliative care unit in hospital Long-term care facility Home Hospice Not sure, please recommend Order notes: Thank you!
