| 75773-2 | Reported | |
| 75774-0 | AD pref despite mental stte Reported | |
| 75775-7 | Role religion faith culture spirit Rptd | |
| 75776-5 | Support pal care team pref Reported | |
| 75777-3 | Health info unable interact Reported | |
| 75778-1 | Reported | |
| 75779-9 | Reported | |
| 75780-7 | Reported | |
| 81377-4 | GPP Healthcare Agent Reported | |
| 75781-5 | Thghts organ tissue dntns Reported | |
| 75782-3 | Thoughts regarding autopsy Reported | |
| 81330-3 | Thoughts on intubation Reported | |
| 81331-1 | Thoughts on tube feeding Reported | |
| 81332-9 | Thoughts on IV fluid+support Reported | |
| 81333-7 | Thoughts on antibiotics Reported | |
| 81329-5 | Thoughts on resuscitation Reported | |
| 81341-0 | Circum activate agent's powers Reported | |
| 81342-8 | HC agent appt jrsdctn Reported | |
| 81343-6 | Healthcare agent advisor Reported | |
| 81344-4 | Agent authority re PHI Reported | |
| 81345-1 | Agent auth re protected PHI Reported | |
| 81346-9 | Limitations on healthcare agent Reported | |
| 81347-7 | Consent deviate from stated GPP Reported | |
| 81348-5 | Compensation healthcare agent Reported | |
| 81349-3 | Thghts life-sus px preg Reported | |
| 81350-1 | Thoughts pain management Reported | |
| 81351-9 | DNR, DNAR, or AND exists Reported | |
| 81353-5 | Thoughts hastening death Reported | |
| 81354-3 | Prescribed anticipatory medication Repor | |
| 81355-0 | Loc of anticipatory medication Reported | |
| 81359-2 | Near death thghts+feelings Reported | |
| 81360-0 | My likes and joys Reported | |
| 81361-8 | Things that make me laugh Reported | |
| 81362-6 | My dislikes and fears Reported | |
| 81363-4 | Things that matter to me Reported | |
| 81364-2 | Religious/cultural beliefs Reported | |
| 81365-9 | Religious/cultural aff contact Reported | |
| 81366-7 | Unfinished business Reported | |
| 81356-8 | Death arrangements Reported | |
| 81357-6 | Messages delivered after death Reported | |
| 81358-4 | Person(s) to notify upon death Reported | |
| 81367-5 | Signer for declarant Reported | |
| 81382-4 | Statement of doc creator Reported | |
| 81368-3 | Statement of witness Witness Reported | |
| 81369-1 | First witness | |
| 81370-9 | Second witness | |
| 81371-7 | Third witness | |
| 81372-5 | Notary | |
| 81373-3 | Notary commission expiration date | |
| 81374-1 | Notary seal ID | |
| 81375-8 | Health status Reported | |
| 81376-6 | Mental health tx preferences Reported | |
| 81378-2 | GPP certain health conditions Reported | |
| 81352-7 | MOLST, POLST or similar exists Reported | |
| 81380-8 | GPP for care experience Reported | |
| 81379-0 | GPP upon death Reported | |
| 81381-6 | Admin info for Advance Care Plan | |
| 81340-2 | Goals +or pref priority Reported | |
| 77352-3 | Thghts art nutrit hydration Reported | |
| 75793-0 | Other directives not documented Reported | |
| 75783-1 | Primary HC agent | |
| 75784-9 | First Alt HC agent | |
| 75785-6 | Second Alt HC agent | |
| 75786-4 | Powers granted to HC agent Reported | |
| 75792-2 | Request for resuscitation not CPR | |
| 75787-2 | Request for intubation | |
| 75788-0 | Request for tube feeding | |
| 75790-6 | request IV fluid support | |
| 75789-8 | Request for life support | |
| 75791-4 | Request for antibiotics | |
| 75772-4 | Advance directives panel:-:Pt:^Patient:-:ADVault | |