Advance Care Plan (ACP) Template

Personal Details: [record full name, date of birth, gender, and relevant cultural or linguistic background if available] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Capacity and Consent: [document patient's decision-making capacity, understanding of their condition, and consent for planning discussions] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Understanding of Health Status: [describe patient's understanding of their diagnosis, prognosis, and any expectations for future care] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Personal Values and Beliefs: [outline key values, beliefs, or guiding principles expressed by the patient that inform their care preferences] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Goals for Future Care: [record patient's preferences for treatment outcomes, goals of care, or what is most important to them] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Treatment Preferences: [specify preferences regarding life-prolonging treatments such as resuscitation, ventilation, artificial nutrition or hydration] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Preferred Place of Care: [note preferences for care setting, including preferred location for treatment or end-of-life care] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Substitute Decision-Maker(s): [document legally appointed decision-makers or nominated representatives and their contact details if stated] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Family or Carer Involvement: [record discussions involving family, carers or significant others and their role in decision-making] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Spiritual, Religious or Cultural Considerations: [include any spiritual, religious or cultural factors important to the patient that influence care preferences] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Review Plan: [outline any arrangements for future review of the plan, including who will initiate and when] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Clinician Details: [document name, role, and contact information of clinician completing the plan if stated] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) (Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes or clinical note as a reference for the information include in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely. Use as many lines, paragraphs or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)