Advance Health Directive Form 4 Queensland: How to Fill It Out Section by Section

Getting the Right Version

The current Advance Health Directive form is Form 4, Version 5, available as a free PDF download from the Queensland Government Publications Portal. Use the current form to avoid confusion with hospitals, GPs, and the Statewide Office of Advance Care Planning.

The Publications Portal also has Form 10 — Explanatory Guide to Form 4, which is the government's official companion to the AHD. Download both. Form 10 walks through each section in detail and includes examples. What follows here is a practical interpretation of what each section asks and where people most commonly get stuck.

Section 1: Your Personal Details

Straightforward: your full legal name, date of birth, and address. Use the name that appears on your driver's licence or Medicare card — name mismatches between the AHD and other official documents (like a hospital admission record) can create delays when clinicians try to verify the directive.

Section 2: Appointing an Attorney for Health Matters

This section is optional. If you only want to document treatment preferences (refusals, consents) without appointing someone to make decisions on your behalf, you can skip Section 2 and use Section 3 alone.

If you do appoint an attorney through the AHD, they're specifically a healthcare attorney — their authority is limited to health matters. This is separate from an EPOA, which can cover financial, personal, and health matters. You can have both an AHD healthcare attorney and an EPOA attorney; if their health-related powers overlap, the AHD's specific treatment directions take priority over the attorney's discretion.

Name your attorney by full legal name and provide contact details. If you're appointing a substitute (backup) attorney, name them too. The attorney must sign their acceptance (Section 8) before they can act.

Section 3: Your Healthcare Directions

This is the core of the document — and the section where precision matters most. Section 3 is where you record the specific medical treatments you consent to, refuse, or want provided only in certain circumstances.

Queensland law gives these directions binding legal force. When a valid AHD contains a specific direction that applies to the patient's current clinical situation, the treating team must follow it — even if they disagree with the clinical wisdom of the direction.

Common directions include:

• Refusal of cardiopulmonary resuscitation (CPR) in specified circumstances
• Refusal of mechanical ventilation (intubation)
• Refusal of artificial nutrition and hydration (tube feeding, IV fluids for sustenance)
• Consent to pain management and palliative sedation
• Preferences about antibiotic use for infections
• Preferences about hospital transfer from a residential care facility

The precision problem: Vague language undermines the directive's effectiveness. "No extraordinary measures" is the classic example — it means different things to different clinicians, and when meaning is ambiguous, the default is to treat. Directions should name specific treatments and specify the clinical circumstances under which they apply.

For example: "I refuse mechanical ventilation if I have a terminal illness with no reasonable prospect of recovery and the treating doctor and another doctor agree that death is expected within one year" identifies the treatment and the statutory threshold. "I don't want to be kept alive by machines" is not.

Section 4: Organ and Tissue Donation

An optional section where you can record your wishes about organ and tissue donation. Note that this doesn't replace registration on the Australian Organ Donor Register — it supplements it. In practice, the DonateLife team checks the national register and consults the family; having your wishes documented in the AHD provides additional evidence of your intent.

Section 5: The Capacity Certificate (Doctor's Section)

This is the mandatory medical section that a registered medical practitioner must complete. Without Section 5, the AHD is invalid.

The doctor must:

• Discuss the nature and implications of the AHD with you
• Be satisfied that you have decision-making capacity to make the document
• Sign and date the capacity certificate

Practical tips for the GP consultation:

• Book a longer appointment (at least 30 minutes) — this isn't a quick sign-off
• Bring a draft of your treatment directions (Section 3) so the doctor can review the clinical phrasing and suggest improvements
• If you have specific conditions (dementia risk, cardiac disease, cancer), the doctor can help you anticipate which treatment decisions are most likely to arise and phrase your directions accordingly
• The doctor does NOT need to agree with your treatment choices — they only need to confirm you understand them

Some GPs aren't familiar with the AHD process. If yours seems unsure, ask specifically whether they're comfortable completing Section 5. If not, consider booking with a GP who specialises in geriatric or palliative care, or ask your specialist to do it.

Section 6: Signing and Witnessing

After the doctor completes Section 5, you sign the document in the presence of an eligible witness. The witness must be a Justice of the Peace, Commissioner for Declarations, Australian legal practitioner, or notary public.

The signing sequence is critical:

1. Doctor completes Section 5 first
2. You sign Section 6 in the witness's presence
3. The witness signs their certification immediately after

The witness cannot be your appointed attorney, a relative of you or your attorney, your paid carer, your healthcare provider, or a beneficiary under your will. Finding a JP is free — check the Queensland Government JP search tool.

Section 7: Interpreter Statement (If Applicable)

If an interpreter assisted during the execution process, the interpreter completes this section certifying that they accurately translated the document and the discussions. This section uses Form 7 if a separate interpreter's statement is needed.

Section 8: Attorney Acceptance

If you appointed a healthcare attorney in Section 2, they must sign Section 8 to formally accept the appointment. They can do this after you've completed the rest of the form — they don't need to be present during your signing. But their powers don't activate until they've signed.

After Completion

Once all sections are complete:

• Upload a copy to The Viewer by sending it to the Statewide Office of Advance Care Planning
• Give certified copies to your appointed attorney, your GP, any specialist you see regularly, and your residential care facility if applicable
• Store the original securely — a fireproof safe, your solicitor's document storage, or the Public Trustee's storage service
• Update My Health Record with a copy, as a secondary backup

The Queensland Advance Directive & Living Will Kit includes section-by-section walkthroughs with clinical phrasing templates for Section 3, a GP consultation preparation worksheet for Section 5, and a witness eligibility checklist for Section 6.

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