Where to Store an Advance Directive in Newfoundland and Labrador

The Most Common Mistake

People finish their Advance Health Care Directive (AHCD), sign it properly with two witnesses and their SDM's written acceptance, and then put it in a place that no one can find when it's needed — a safe, a filing cabinet, a safety deposit box at the bank.

A legally perfect directive locked in a drawer you can't open during a medical emergency is functionally worthless. In Newfoundland and Labrador, where paramedics are legally required to perform full resuscitation unless they can physically locate a documented clinical order stating otherwise, storage isn't an afterthought. It's the difference between your wishes being followed and being ignored.

The Storage Protocol for Newfoundland

1. Your physician's office and NL Health Services

Deliver the original or a clear copy to your family physician or nurse practitioner. Ask them to integrate it into your electronic medical record within the NL Health Services system.

When your directive is integrated into your medical chart, it can be available to clinicians with chart access during a hospital admission or emergency department visit. This doesn't help paramedics in your home, but it provides coverage once you're in a healthcare facility.

2. Your Green Sleeve on the refrigerator

This is the critical home-based storage step. The Green Sleeve — a visible green plastic pocket that hangs on your refrigerator door — is the standardized location where NL emergency responders are trained to look for advance care documentation.

Your Green Sleeve should contain:

• Your original AHCD
• Your active Goals of Care Designation (GCD) order (issued by your physician)
• An emergency contact sheet listing your SDM and their phone number

The fridge location is deliberately conspicuous. Paramedics arriving at a home emergency check the refrigerator as part of their standard protocol.

3. Your Substitute Decision Maker

Your SDM needs their own copy — both so they can reference your specific instructions when making decisions and so they can present it to clinical staff if needed. If your SDM lives in a different city or province, consider giving them both a physical copy and a digital scan.

4. Close family members

Give copies to immediate family members who are likely to be present during a medical emergency or who may interact with healthcare providers on your behalf. This serves a dual purpose: it ensures someone nearby can produce the document quickly, and it reduces the risk of family disputes by making your wishes widely known.

5. A wallet card

Carry a card in your wallet or purse that states:

• "I have an Advance Health Care Directive"
• The name and phone number of your SDM
• Where the original document is stored

This is especially useful if you have a medical emergency away from home — in a restaurant, at a store, while travelling within the province. Emergency responders or hospital staff who find the card know to contact your SDM and request a copy of the directive.

What About Digital Storage?

MyHealthNL

NL Health Services operates the MyHealthNL digital health portal, which provides patients with access to some of their medical records. If your physician has integrated your AHCD into your electronic chart, it may be accessible through this portal.

However, MyHealthNL is primarily designed for patient self-service — lab results, appointment scheduling, medication lists. Its usefulness as an emergency access point for advance directives is limited. Paramedics at the scene won't be logging into your MyHealthNL account.

Any patient-portal copy is a reasonable supplementary step, but NL has no centralized province-wide digital registry for health directives, and digital access doesn't replace the physical Green Sleeve or the copy in your physician's chart.

Personal digital copies

Scanning your AHCD and storing it in a cloud service, emailing a copy to your SDM, or saving it on your phone are all practical backup measures. But digital copies on personal devices present access challenges: your phone may be locked, your cloud service requires login credentials, and a scanned copy of a directive doesn't carry the same immediate clinical authority as a Green Sleeve GCD order.

Use digital storage as a backup layer, not a primary strategy.

Where Not to Store It

Safety deposit boxes. Banks are closed on weekends, evenings, and holidays — exactly when many emergencies occur. Even during business hours, accessing a safety deposit box requires the keyholder or a court order. If you're incapacitated, neither is possible on the timeline emergency care demands.

Locked home safes. If you're unconscious and your SDM doesn't know the combination, the directive is inaccessible. Paramedics will not attempt to open a safe.

With your lawyer only. Lawyers' offices keep business hours. A directive stored exclusively with your solicitor provides no emergency access at 3 AM on a Saturday.

The Distribution Checklist

After executing your AHCD, verify that copies have reached:

• [ ] Your family physician / NL Health Services (for your medical chart)
• [ ] Your Green Sleeve (refrigerator door)
• [ ] Your SDM
• [ ] Immediate family members
• [ ] Your wallet (emergency card)
• [ ] Your personal care home or long-term care facility (if applicable)
• [ ] Digital backup (MyHealthNL, email to SDM, cloud storage)

The Newfoundland and Labrador Advance Directive & Living Will Kit includes a distribution tracker, an emergency wallet card template, and the Green Sleeve setup instructions — so your directive is findable everywhere it needs to be, not just legally valid where no one can see it.

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