To submit a case packet, download the Major Medical Treatment (200 series) or End-of-Life (300 series) forms below. Submit full packet of completed forms via fax to 518-549-0460; via secure email; or by mail to: NYS Justice Center for the Protection of People with Special Needs, SDMC Program, 401 State Street, Schenectady, NY 12305.

Please contact SDMC staff with questions at 518-549-0328 or [email protected].


Major Medical Treatment Forms (200 series)

200: Declaration for Major Medical Treatment

210: Certification on Capacity for Major Medical Treatment

220-A: Certification on Need for Major Medical Treatment

220-B: Related Medical Information

Or download the full packet of 200 Series Forms

 

End of Life Forms (300 series)

300: Declaration for End of Life Care

310: Certification on Capacity for End of Life Care

320-AB: Attending Physician and Concurring Physician Certification for End of Life Care

330: Related Medical Information for End of Life Care

Or download the full packet of 300 Series Forms

 

Resources and Help with Forms

Sample forms have been provided below to assist you as you fill out the paperwork. Please call SDMC at 518-549-0328 for further assistance.


Sample Major Medical Treatment (200 series) Forms

200: Declaration for Major Medical Treatment (Sample)

210: Certification on Capacity for Major Medical Treatment (Sample)

220-A: Certification on Need for Major Medical Treatment (Sample)

220-B: Related Medical Information (Sample)

 

Sample End of Life (300 series) Forms

300: Declaration for End of Life Care (Sample)

310: Certification on Capacity for End of Life Care (Sample)

320AB: Attending Physician and Concurring Physician Certification for End of Life Care (Sample)

330: Related Medical Information for End of Life Care (Sample)