Advance Care Planning: Communicating With Outpatients for Vital Informed Decision

Inclusion Criteria: * Clinic Eligibility: Clinics affiliated with Northwell Health may be included in the study. * Clinician, Staff Eligibility: Any staff member identified by the site-PIs are affiliated with Northwell Health. * Patient Eligibility: To be eligible for this study, individuals must be aged 65 or over, affiliated with the Northwell Health clinic. For each of the three periods of the study, those patients over the age of 65 who are engaged (e.g., seen in person, telehealth, etc.) with the clinic during that time period will be included in that time period Exclusion Criteria: * Individuals who are not yet adults (infants, children, teenagers) * Pregnant women * Prisoners