Provider Authorization and Obligations
- Vermont Advance Directive Registry

How to Become an Authorized Provider

Complete the following forms and submit them to the Vermont Department of Health

Vermont Advance Directive Registry
Vermont Department of Health
108 Cherry Street, Room 304
P.O. Box 70
Burlington, VT 05402-0070

Vermont Department of Health will review and approve applications. Once approved, the Registry will contact the provider with instructions and registry account number.

Providers issued a registry user account shall

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Notification of Changes

Providers are obligated to notify the registry when they become aware of changes to an advance directive.

Complete and mail or fax the notification form to the registry:

Vermont Advance Directive Registry
PO Box 2789
Westfield, NJ 07090

Fax: 908-654-1919

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Definitions

An advance directive is a legal document that conveys a person's wishes regarding their health care treatment and end of life choices, should they become incapacitated or otherwise unable to make those decisions. The document may include an appointment of an agent, identification of a preferred primary care physician, healthcare wishes, anatomical gifts, disposition of remains, terminal care document or similar documents.

The term provider is used by the registry to include health care providers, health care facilities, residential care facilities, probate court officials, procurement organizations, funeral directors, crematory operations and cemetary officials.

An authorized provider is an individual or organization that has been approved by the Department of Health for unlimited secure access to the registry.

A registrant is an individual who has submitted an advance directive or an Advance Directive Locator form to the Registry, and received written confirmation that the advance directive is registered.

Vermont Advance Directive Registry (Registry) is a secure, web-based database to which individuals may submit, at no charge, an advance directive or an Advance Directive Locator form and other documents which amend, suspend or revoke an advance directive. The documents are electronically stored and may be accessed by providers through the Internet or by telephone.

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Support Contact Information

Email: techsupport@uslivingwillregistry.com

Call: 1-800-548-9455
Monday to Friday, 9:00 am - 5:00 pm

Emergency After Hours Support: 1-888-548-9455.

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