PSP End of Life Care Algorithm - GPSC

■ Quality ■ Integrity ■ Respect ■ TrustMy Advance Care PlanThis section is designed to be separated from the rest of thedocument, photocopied, and given to your doctor, family members,substitute decision-maker and/or trusted friends.QualityRespectIntegrityTrustRespectTrustCaringMy rst name:Last name:My date of birth:My Care Card #:My address:My phone number: ( )My cell phone number: ( )My email address:Middle initial(s):The following people have copies of this Advance Care Plan:Name Relationship to me Phone Number( )( )( )( )( )( )1-877-825-5034www.fraserhealth.ca© Fraser Health Authority 2007349976 Rev. Sept. 21, 2007 R-47