Spiritual Care Advance Directive
to encourage, facilitate, and authorize the partnership of care between my health care providers and 
my faith community/spiritual care providers

You Can Benefit From Having a Spiritual Care Advance Directive!

To provide you prompt and excellent spiritual care in times of a health care crisis or transition your Faith Community Spiritual Care Provider needs to be informed promptly of your needs and your condition.  For a variety of reasons you or your loved ones may not be able to provide this information. 

Health Care Providers are not permitted to share important medical information about you with others including your Faith Community/Spiritual Care Providers under current HIPAA (The Health Insurance Portability and Accountability Act of 1996 Privacy and Security Rules) regulations.

The Spiritual Care Advance Directive empowers you (or your decision makers) to authorize the release of certain private health information (often abbreviated PHI) to facilitate your spiritual care.  The Spiritual Care Advance Directive form, instructions, and related information pages can be downloaded and printed for free from this website.

If you desire spiritual care in times of a health care crisis or transition and you want to facilitate a partnership between your health care providers and your spiritual care providers, then consider how this Spiritual Care Advance Directive may help you.

A personal word from the creator of the Spiritual Care Advance Directive to individuals, their loved ones, Spiritual Care, & Health Care Providers

I have been a patient and I have had loved ones in long-term care facilities.  I have been a pastor in a church and a chaplain in both hospitals and long-term care facilities.  In the Spiritual Care Advance Directive I have tried to merge all these perspectives to facilitate communication and team work that respects each one’s needs, responsibilities, and right to privacy.  I hope this is a tool that will benefit patients and families, spiritual care providers, and health care providers.

If you have comments or questions or experiences to share regarding the value and use of this Spiritual Care Advance Directive, please email me.

If you would like a program, lecture, or workshop on this subject with any group, social, civic, faith, or professional, please email me.  If you would like to know more about me, I invite you to visit my personal website at thegospelofjim.com.

I am grateful to the counsel of spiritual care providers, faith community lay members, and health care professionals in developing this Spiritual Care Advance Directive.  Special appreciation goes to the executive leadership of United Church Homes, Inc. for their counsel and support.

Jim Cunningham

Pastor and Health Care Chaplain