Advance Directives

Advance Directives

Perry Memorial Hospital has a commitment to the preservation of life and alleviation of suffering.  Therefore, every patient admitted to the hospital will receive total life support, including resuscitation, unless a decision not to resuscitate (to revive from apparent death) has been previously made.  Social Services is the department which handles Healthcare Advance Directives.


 A licensed medical Social Worker is available to help you plan ahead for your needs after discharge.  Your concerns will be handled competently and confidentially.  The Social Worker will assist you…

–            in planning for discharge to home, nursing home or other facility, including referrals when necessary.

–             by advising you and your family of community resources available during and after hospitalization and making referrals for continuity of care and planning.

–             by providing support to cope with the stress which may result from difficult medical diagnosis or treatment.

–             by providing you with written information and forms in Illinois Advance Directives.

–             by answering any questions regarding Advance Directives and the hospital’s policy on Advance Directives.

 Social Services assistance may be requested by any one – patient, family or hospital staff.  You may call extension 2152 or ask your physician or nurse to contact the Social Worker for you.  You may also call Social Services directly by dialing 815-876-2152.  There is no fee for this service.


 The hospital participates in the organ and tissue donation program with Gift of Hope, Musculoskeletal Transplant Foundation and the Illinois Eye Bank.  If you would like more information on how you can be a donor, or about the donor program, please talk with Social Services or a nursing supervisor.

It is the policy of Perry Memorial Hospital to recognize the rights of its patients to make informed decisions about their medical care (including the right to accept or refuse medical or surgical treatment, including life-sustaining care, even if the refusal could hasten death), and the right to formulate advance directives.  Additionally, this hospital recognizes the rights of patients lacking decisional capacity to have surrogates, as provided by law, who may make decisions on their behalf.

 Further, it is the policy of Perry Memorial Hospital to comply with applicable law and to promote patients’ self-determination by encouraging the use of advance directives and honoring treatment preferences expressed by patients and their advance directives, so long as those preferences are allowed by law.

 In so doing, it is this hospital’s policy not to condition care or discriminate against individuals based on whether they have executed an advance directive, nor to require any person to execute an advance directive.


  1. Every adult patient will be asked on admission if he/she has executed an advance directive.
  2. If the patient has an advance directive he/she will be asked to provide a copy which will become a part of the patient’s hospital record.
  3. If the patient has an advance directive on file in the hospital, they will be asked if it is up-to-date, then a copy will be made and it will become part of the patient’s medical record.
  4. A summary of the Perry Memorial Hospital Administrative Policy on the Patient Self-Determination Act, including a definition of terms and the statement of Illinois law on Advance Directives, will be made available to every adult patient.
  5. In case of an emergency or the patient’s inability to participate in the admission process, the patient will be given the care deemed appropriate by the physician.  The questions and information will be directed to the patient’s agent or surrogate as determined by the order of priority in the Health Care Surrogate Act.
  6. Questions about advance directives may be directed to the Social Services Department (Ext. 2152), the patient’s physician or a member of the Ethic’s Committee.  You may contact a member of the Ethic’s Committee by asking the nursing supervisor or a social service staff member.

Site: Kelly Wilson / Cre8ive Options