Referral to Advance Care Planning Program

Referral Guidelines and referral form


Advance Care Planning is about planning ahead for your future healthcare, in case you are ever too sick to speak for yourself. A simple way to understand and do advance care planning is ACP in 3 steps:

A: Appoint an Agent

You can sign a legal form making it clear who you want to make MEDICAL DECISIONS for you if you are too sick to do it yourself. This is a ‘Medical Enduring Power of Attorney’.

C: Chat & Communicate

Talk to your family, friends, and doctors about your values, beliefs and health care preferences. Tell them about what is important for you. Also, talk to your doctors or other health professionals to find out more about what might be ahead.

P: Put it on Paper

If there is something you feel strongly about, you can write it down in an Advance Care Plan / Directive or in a letter describing your health care values and preferences for future medical treatments, including what type of medical treatment you would agree to, and what you would not want.

It is important we all consider Advance Care Planning, however, it is particularly important if:

  • You are over 75 years of age
  • You have chronic health issues
  • Have health conditions that may affect your ability to make decisions in the future
  • You have firm preferences about future medical treatment
  • You have no-one, or no-one suitable, that you could appoint as a Medical Enduring Power of Attorney
  • You have preferences for your health care that are different from what you think your family would want for you.


Advance Care Planning English
Advance Care Planning Aboriginal
Advance Care Planning Chinese
Advance Care Planning Greek
Advance Care Planning Italian
Advance Care Planning Khmer
Advance Care Planning Persian
Advance Care Planning Vietnamese

Advance Care Planning Documents

Getting Started Workbook
Advance Care Directive Form
Instructions for Completing Advance Care Directive
Appointment of Medical Treatment Decision Maker
Checklist for Appointing Medical Treatment Decision Maker
Appointment of Support Person
Checklist for Appointing Support Person
Office of Public Advocate Take Control

Making medical decisions for another person

Consumer Guide – Making decisions for another person – For when the person lacks capacity to undertake advance care planning.

Preferences and Values form for another person – This form records information about a person who cannot express their preferences about medical treatment. What you write in this form will help the Medical Treatment Decision Maker and health professionals to make medical decisions that the person would want. This form is only for people who cannot make medical decisions or express what they want.

Sharing your ACP documents with Monash Health

Lodging Advance Care Planning document with Monash Health



Advance Care Planning Australia

Department of Health and Human Services- Advance Care Planning

Medical Treatment 1988 

Office of the Public Advocate
Phone: 1300 309 337

Advance Statements for Compulsory Mental Health Treatment 

Seniors Rights Victoria  
Phone: 1300 368 821

ACP Talk – for sensitive religious and cultural advance care planning

Caring for Muslim Patients

Victorian Civil and Administrative Tribunal
Phone: 9628 9911

Victorian Legal Aid
Phone: 9269 0120

Information Sessions

Information sessions
Please contact the Advance Care Planning program if you would like to arrange an information session for your service/organisation
Phone: 9594 3475