Provider Authorization and Obligations

Provider Authorization and Obligations

Become an Authorized Provider

Complete these forms and submit them to the Vermont Department of Health.

Advanced Directive Provider Application and Agreement

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


The 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:

  • Protect the identification number issued to the provider and limit access to the identification number to their employees with a need to access the registry.
  • Train their employees on the proper use of the registry and the registrants’ documents, and the obligation to report any unauthorized access or misuse of information to the Vermont Department of Health.
  • Inform the registry as soon as possible, in writing, of any change or proposed change to the information contained in the original Provider Access Application form submitted to the registry.
Notification of Changes

Providers are obligated to notify the Advance Directives 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 07091-2789

Fax: 908-654-1919

Definition of Terms

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.

Support Contact Information


TEL 1-888-548-9455
Monday to Friday, 9:00 am - 5:00 pm

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