Power of Attorney and Patient Advocate
We all want to make our own choices about the medical treatment we receive. Sometimes we are not able to make those decisions because of a medical condition.

It is important to have a plan in place to make sure that our wishes are followed. This plan is called an Advance Directive. The Advance Directive should:

• Describe the type of medical care you want
• Describe the type of medical care you do not want
• State who you want to make decisions about your care if you cannot
• Be reviewed once a year

A Durable Power of Attorney document is used to choose a person to make decisions about your medical treatment and care.

The Durable Power of Attorney document must be signed by you and witnessed by two adults. Witnesses cannot be:

• A family member
• The patient advocate
• An employee of the healthcare facility where you are a patient

The person you choose to make decisions about your medical treatment and care is called a patient advocate. A patient advocate:

• Must be at least 18 years old
• Able to make decisions and handle the responsibility
• Know your wishes
• Is willing to follow your wishes
• Is willing to be the patient advocate

Your spouse, adult child, other relative or a friend can be the patient advocate. You should talk with this person before you sign your form. You can select a second person in case the first person cannot act as the patient advocate. The person or persons you choose must also sign an acceptance form. You can change your mind and choose someone else later by signing a new document and destroying the old one.

The patient advocate only makes decisions if you cannot make decisions for yourself. For example, if you have a stroke or a head injury, your doctor and one other doctor would have to decide that you could no longer make decisions before asking the patient advocate.

You can give your patient advocate the power to:

• Consent to or refuse medical treatment
• Arrange for home healthcare
• Admit you to a nursing home
• Withhold or stop treatment
• Withhold or stop food and water

You should be very clear about what you want and what you expect the patient advocate to do for you. Your patient advocate has a duty to follow your wishes to the best of their ability.

There is no standard form for this document. You can use Bronson's form or one from somewhere else. You may write your own or have a lawyer create one for you. Call Medical Social Work at (269) 341-7943 with questions or for a copy of the form.

Emergency Medical Care Consent
Medical emergencies can happen to your child anytime, anywhere - at school, at daycare, when you're away from home, when your child is staying with someone else.  Fortunately, there is an important way you can make sure your child will get prompt treatment when you're not there.  

Complete a Consent for Treatment of a Minor form for each your children and leave it with your babysitter, friend, relative, or daycare provider - anyone taking care of your child.  Make sure the person keeps the completed consent form in a place where it is easy to find.  Also, make sure that person understands that the consent form should be taken to the emergency room along with the child.

Release of Information from Medical Record
To request a copy of your Bronson Methodist Hospital medical record, please mail or fax the completed Release of Information form. Be sure to sign the form. Unsigned requests cannot be processed.

• Fax: (269) 341-7714
• Mailing address:
  Bronson Methodist Hospital
  601 John Street, Box F
  Kalamazoo, MI 49007

Your request will be processed and fulfilled within ten working days. We will either mail records to the address specified on the authorization form, or you may pick up your copy from our office located at the address above 8 a.m. to 4:30 p.m., Monday through Friday.

For more information, please contact Bronson Health Information Management at (269) 341-6024.

To request a medical record from your doctor, please contact your doctor's office directly.