Green Sleeve Alberta: What Goes Inside and Where to Keep It

What the Green Sleeve Actually Is

The Green Sleeve is a bright green plastic folder used across Alberta Health Services (AHS) to hold three specific clinical-legal documents for a patient. It is the physical link between what your parent wants and what paramedics, emergency staff, and care home nurses actually do during a crisis.

Every Alberta paramedic is trained to look for it. When they enter a home on a 911 call, they check the refrigerator first — that is the standardized storage location across the province.

The Green Sleeve is not a legal document itself. It is a container that holds the documents that direct care. If the sleeve is missing, empty, or outdated, the responding team may not have the current documents needed to follow the patient's documented wishes during a crisis.

The Three Documents Inside

1. Goals of Care Designation (GCD) Order

The GCD is a formal medical order signed by a physician or nurse practitioner. It translates the patient's values and treatment preferences into specific clinical instructions using standardized letter-number codes:

• R (Resuscitative Care): Full intervention including CPR, intubation, ICU admission
• M (Medical Care): Active medical treatment and symptom management, but no ICU-level critical care or resuscitation
• C (Comfort Care): Focus on comfort, pain management, and allowing a natural death — typically no hospital transfer unless needed for symptom control

The GCD is not a one-time decision. It should be reviewed and updated at every major health transition — after a hospitalization, when moving between care settings, when a new diagnosis changes the trajectory, or when the patient's wishes evolve.

2. A Copy of the Personal Directive

The Personal Directive names the agent who has authority to make healthcare and personal decisions when the patient lacks capacity. Including a copy in the Green Sleeve means the paramedic or emergency physician can immediately identify who the substitute decision-maker is, without calling the OPGT registry or waiting for family to produce the original.

3. The Advance Care Planning (ACP) Tracking Record

This form documents the ongoing conversations between the patient, their agent, and the healthcare team about values, expectations, and specific treatment preferences. Clinical staff update it as care goals shift. It provides context for the GCD — not just what the order says, but why.

Where to Keep It

On or near the refrigerator door at home. This is not a suggestion — it is the provincial standard. AHS paramedics are trained to check the fridge location on every residential emergency call.

If your parent lives in a continuing care home or supportive living facility, the staff typically manage the Green Sleeve and keep it in the medical chart at the nursing station. But for aging parents living independently or with family, the fridge protocol is what makes the system work.

Some families keep the Green Sleeve in a desk drawer or a filing cabinet "for safekeeping." That defeats the purpose entirely. A paramedic responding to a cardiac arrest does not have time to search the house.

How to Get One

AHS distributes Green Sleeves through hospitals, care facilities, and AHS home care coordinators. Your parent's family physician can also provide one, and the AHS website has printable forms for the GCD and ACP tracking record.

If your parent is being discharged from hospital, ask the discharge planner for a Green Sleeve before leaving. Hospital discharge is the most common point where families assemble these documents — the GCD discussion typically happens during the admission, and the sleeve goes home with the patient.

Common Mistakes

Outdated GCD order. The Green Sleeve sits on the fridge for years without being updated. The GCD from three years ago may not reflect current wishes — particularly after a dementia diagnosis or a major health decline that changes what "good care" means.

Missing Personal Directive. The sleeve has the GCD but no PD copy. Paramedics can follow the medical order, but if the situation requires a substitute decision-maker (surgery consent, care home placement decision), there is no record of who that person is.

No sleeve at all. Many families complete the legal documents — EPA and Personal Directive — but never connect them to the clinical system through a Green Sleeve. The legal documents sit in a lawyer's safe. The clinical team has no record of the patient's wishes on a Friday night.

The Alberta Power of Attorney & Personal Directive Kit includes a Green Sleeve Assembly Checklist that walks through each document, what goes in the folder, and how to coordinate the clinical and legal sides so nothing falls through the gap.

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