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Justice Center for the Protection of People with Special Needs

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Agency Directory

  • Surrogate Decision-Making Committee (SDMC)
    • Introduction to Surrogate Decision-Making Committee (SDMC)
    • View SDMC Mock Hearing
    • SDMC Forms
      • Forms Needed for Major Medical Treatment
        • Certification on Capacity for Major Medical Treatment (210)
        • Certification on Need for Major Medical Treatment (220A)
        • Declaration for Major Medical Treatment (200)
        • Supplemental Medical Information (220B)
      • Sample Forms Needed for Major Medical Treatment
        • Sample - Declaration for Major Medical Treatment (200)
        • Sample - Certification on Capacity for Major Medical Treatment (210)
        • Sample - Certification on Need for Major Medical Treatment (220A)
        • Sample - Supplemental Medical Information (220B)
      • Forms Needed for End of Life Care
        • Declaration for End of Life Care (300)
        • Certification on Capacity for End of Life Care (310)
        • Attending Physician and Concurring Physician Certification for End of Life Care (320 AB)
        • Supplemental Medical Information (330)
      • Sample Forms Needed for End of Life Care
        • Sample - Declaration for End of Life Care (300)
        • Sample - Certification on Capacity for End of Life Care (310)
        • Sample - Attending and Concurring Physician Certification for End of Life Care (320AB)
        • Sample- Supplemental Medical Information (330)
      • Sample MOLST Checklist with 380-A
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        • Standing Wheelchairs Funding Request Checklist
          • Sample Letter of Medical Justification for a Standing Wheelchair
          • Sample Supporting Letter of Medical Justification for a Standing Wheelchair
          • Pediatric Power Wheelchair with Accessories
          • Sample Letter of Medical Justification for Pediatric Power Wheelchair
          • Sample Supporting Letter for Medical Justification for Pediatric Power Wheelchair with Accessories
      • AT Training
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Justice Center for the Protection of People with Special Needs

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