Specific decision-making instructions - Alberta Human Services - Government of Alberta

Specific decision-making instructions

Learn how specific decision-making happens and who makes decisions.

What’s important to know

Specific decision-making is only for a one-time, time-sensitive decision about:

  • health care and/or
  • temporary admission to or discharge from a residential care facility

This is the form for specific decision-making.

Form 6: Assessment of Capacity of Adult to Make Decisions Respecting the Adult’s Health Care

Some web browsers, such as Chrome and Mozilla Firefox, don’t open fillable PDF forms on our site; Internet Explorer 8.0 or higher works best.


Show Answer Step 1: Health care provider determines whether the adult can make their own decisions

The health care provider (a physician, nurse practitioner, or dentist for dental care only) does an assessment to determine whether the adult can make their own decisions. If the adult can’t, the health care provider completes Part 1 of the form below:

Show Answer Step 2: Health care provider selects a relative from a ranked list

The health care provider selects a relative from a ranked list:

  • spouse or adult interdependent partner – adult interdependent partner is a term used to describe a variety of personal relationships that fall outside of marriage, including committed platonic relationships where two people agree to share emotional and economic responsibilities
  • adult son or daughter
  • father or mother
  • adult brother or sister
  • grandfather or grandmother
  • adult grandson or granddaughter
  • adult uncle or aunt
  • adult nephew or niece

The relative must:

  • be 18 years of age or older
  • be available and willing to make the decision
  • have had contact with the adult within the past 12 months

There can’t have been a dispute between the relative and the adult that may affect the relative’s ability to carry out their duties.

If there is no relative available from the ranked list or if there is a conflict among the relatives about who can make the decision, the Office of the Public Guardian and Trustee can make the decision.

In this case, the health care provider completes the form below:

Show Answer Step 3: Relative signs the form

Show Answer Step 4: Relative makes the decision

The relative can only make a decision about the area outlined on the form. Their authority is temporary.

While making the decision, they should consult with the adult as much as possible.

As soon as they can, they must contact the next person from the list of ‘nearest relatives’ (see step 2 above) to let them know about the decision. If there is no nearest relative, then they must notify the Public Guardian of the decision.

Show Answer Step 5: Health care provider records the decision

The health care provider completes Part 3 of the form below:

Show Answer What if there is a disagreement?

If someone believes the adult can make their own decisions or if they disagree with the decision that has been made:

  • they must tell the health care provider about their concerns. If they do, the health care provider can’t act on the decision made by the relative
  • they also have to act on their concerns. They have 7 days to either:

If they don’t follow through within 7 days, the health care provider can act on the decision made by the relative.

Created:
Modified: 2015-10-01
PID: 17850

Contact this service

1-877-427-4525 (toll-free)

8:15 am - 4:30 pm (Monday to Friday, closed statutory holidays)