CHAA Advance Directives and Patient Rights 1 — Questions and Answers
Question 1: Which document allows a patient to designate another person to make healthcare decisions on their behalf if they become incapacitated?
- Living Will
- Healthcare Power of Attorney (Correct answer)
- DNR Order
- Informed Consent Form
Correct answer: Healthcare Power of Attorney
A Healthcare Power of Attorney (also called a healthcare proxy or durable power of attorney for healthcare) legally designates a surrogate decision-maker for the patient.
Question 2: A patient presents at registration and states they have a Do Not Resuscitate (DNR) order. What is the MOST appropriate first action for the Patient Access associate?
- Place a copy of the DNR in the medical record and notify the nursing staff (Correct answer)
- Advise the patient that DNR orders must be signed by the attending physician to be valid
- Proceed with registration and disregard the DNR until the physician reviews it
- Contact the hospital ethics committee before proceeding
Correct answer: Place a copy of the DNR in the medical record and notify the nursing staff
The associate should document and communicate the existing DNR to clinical staff so the order is respected throughout the patient's care.
Question 3: Under the Patient Self-Determination Act (PSDA), which of the following is a REQUIRED action for hospitals at the time of admission?
- Require all patients to complete an advance directive
- Provide written information about the patient's right to accept or refuse treatment and to formulate advance directives (Correct answer)
- File a copy of any advance directive with the state health department
- Obtain physician countersignature on all advance directives
Correct answer: Provide written information about the patient's right to accept or refuse treatment and to formulate advance directives
The PSDA mandates that hospitals provide patients with written information about their rights regarding advance directives at the time of admission, but cannot require patients to have one.
Question 4: A living will is BEST described as:
- A legal document designating a surrogate healthcare decision-maker
- A written record of a patient's wishes regarding specific medical treatments if unable to communicate (Correct answer)
- A physician's order limiting resuscitation efforts
- A financial document outlining the patient's ability to pay for care
Correct answer: A written record of a patient's wishes regarding specific medical treatments if unable to communicate
A living will is an advance directive that documents a patient's specific wishes about medical treatments (e.g., ventilators, feeding tubes) when they can no longer communicate.
Question 5: Which federal law establishes patients' rights to make decisions about their own healthcare and requires providers to maintain written policies on advance directives?
- EMTALA
- HIPAA
- Patient Self-Determination Act (PSDA) (Correct answer)
- Stark Law
Correct answer: Patient Self-Determination Act (PSDA)
The Patient Self-Determination Act of 1990 requires Medicare/Medicaid-participating facilities to inform patients of their rights to make healthcare decisions and to maintain written advance directive policies.
Question 6: A patient's family member arrives and demands to know the patient's diagnosis, but the patient has not listed this individual on their HIPAA authorization form. The Patient Access associate should:
- Provide a summary of the diagnosis since the person is family
- Decline to share information and explain that authorization is required (Correct answer)
- Ask the family member to wait while retrieving the medical record for review
- Transfer the call to the attending physician to decide
Correct answer: Decline to share information and explain that authorization is required
Without a signed HIPAA authorization or the patient's verbal permission, protected health information cannot be disclosed to anyone, including family members.
Question 7: A POLST (Physician Orders for Life-Sustaining Treatment) form differs from a standard advance directive primarily because it:
- Only applies to patients over the age of 65
- Is a physician-signed medical order that is immediately actionable by emergency personnel (Correct answer)
- Requires notarization to be legally valid
- Can only be created in an inpatient hospital setting
Correct answer: Is a physician-signed medical order that is immediately actionable by emergency personnel
A POLST is a medical order signed by a physician that translates patient wishes into actionable orders, allowing EMS and other providers to follow them without additional authorization.
CHAA Advance Directives and Patient Rights 1
Which document allows a patient to designate another person to make healthcare decisions on their behalf if they become incapacitated?