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Advance Directive Forms

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An advance directive is a combination of a medical power of attorney and a living will that allows a person to choose their end-of-life treatment options and nominate an agent to make health care decisions on their behalf. An advance directive also allows an individual to make organ donation selections and to decide whether or not he agent will also be a conservator of their estate. Most states provide advance directives forms for free through

By State

Contents

What is an Advance Directive?

An advance directive allows a patient to make many medical decisions for themselves in advance in case they cannot speak for themselves or make important decisions (a state referred to as being “incapacitated”). This is common before someone undergoes surgery or if they starting showing signs of onset of dementia or other mind-altering conditions.

In most states, there are five (5) parts to an advance directive:

How to Get an Advance Directive

The five (5) steps below provide instruction on how a person of sound mind can obtain an advance directive in their state.

Step 1 – Qualify

Any person residing in the United States is qualified to create an advance directive, except those that fall under any of the following categories:

  • Under eighteen (18) years of age
  • Incapacitated
  • Incarcerated (in jail)
  • Outside of the country and not able to return

Conservatorship / Guardianship – If a person is already incapacitated, a spouse or family member may need to seek an attorney so they can apply for conservatorship or guardianship. This is can be filed immediately to make medical and financial decisions for someone else.

Step 2 – Make Decisions About Your Health Care

For the living will section, the principal will need to decide whether or not to withhold end-of-life treatment options such as breathing assistance, artificial nutrition and hydration, and prolonged relief from pain.

In addition, the principal will be able to make decisions about where their organs will go after their death (i.e., donation options), as well as selecting their preferred primary care physician.

Step 3 – Choose an Agent

For the medical power of attorney section, the principal will need to decide who to select as their agent (also known as a “proxy” or “attorney-in-fact”). In most cases, the agent selected is the spouse, a family member, or a close friend.

An advance directive does not usually allow co-agents, but it does allow alternate agents in the event the first (1st) selected agent is unable to serve.

Step 4 – Sign the Form

An advance directive is not complete until it has been executed in accordance with the signing requirements of the principal’s state of residence. This often involves the principal and their agents signing the document in the presence of two (2) witnesses, a notary public, or both.

In the case of using witnesses, most states require that a witness cannot be the following individuals:

  • A family member;
  • A beneficiary of the principal’s Last Will and Testament;
  • A health care professional; or
  • A person under the age of 18.

Step 5 – Make Copies and Distribute

After the advance directive has been properly executed, it should be distributed to all healthcare agencies of the principal including their primary care physician. Most importantly, the agents of the principal should all receive copies so they can effectively communicate the principal’s wishes in the unfortunate circumstance they can no longer speak for themselves.

Step 6 – Registry Filing (optional)

This step isn’t required, but some states have a registry where the principal can record the advance directive to prove its existence. There are national registries that may be used such as the U.S. Living Will Registry and DocuBank that help to ensure the form is safely stored.

Filing an advance directive in an official registry helps to safeguard against any family member or third (3rd) party disagreeing with the principal’s intentions that are outlined in the form.


Advance Directive: Laws

The Uniform Health-Care Decisions Act is a federally recognized law that has been adopted in seven (7) states (Alaska, Delaware, Hawaii, Maine, Mississippi, New Mexico, and Wyoming). Each state has it’s own laws pertaining to the execution and application of advance directives.

STATE SIGNING REQUIREMENTS STATUTE
Alabama 2+ Witnesses § 22-8A-4(c)(4)
Alaska 2 Witnesses OR Notary § 13.52.010(b)
Arizona 1 Witness OR Notary § 36-3282(5)
Arkansas 2 Witnesses § 20-17-202(a)
California 2 Witnesses OR Notary § 4673(3)
Colorado 2 Witnesses § 15-18-106(1)
Connecticut 2 Witnesses § 19a-575
Delaware 2+ Witnesses § 2503(b)(1)(d)
Florida 2 Witnesses § 765.202(1)
Georgia 2 Witnesses § 31-32-5(c)
Hawaii 2 Witnesses OR Notary § 327E-3
Idaho N/A No statute
Illinois 2 Witnesses 755 ILCS 35/3
Indiana 2 Witnesses § 16-36-4-8(b)(5)
Iowa 2 Witnesses § 144A.3(2)(a)
Kansas 2+ Witnesses § 65-28,103(a)
Kentucky 2 Witnesses OR Notary § 311.625
Louisiana 2 Witnesses RS 40:1151.4(A)(2)(b)
Maine 2 Witnesses § 5-803(2)
Maryland 2 Witnesses § 5–602(c)(1)
Massachusetts N/A No statute
Michigan N/A No statute
Minnesota 2 Witnesses OR Notary § 145B.03(2)(a)
Mississippi 2 Witnesses OR Notary § 41-41-205(2)(a)
Missouri 2 Witnesses § 459.015(4)
Montana 2 Witnesses § 50-9-103(1)
Nebraska 2 Witnesses OR Notary § 20-404(1)
Nevada 2 Witnesses NRS 449A.618
New Hampshire 2 Witnesses OR Notary § 137-J:14
New Jersey 2 Witnesses OR Notary § 26:2H-56
New Mexico Principal’s Signature § 24-7A-2(B)
New York N/A No statute
North Carolina 2 Witnesses § 90-321(c)(3)
North Dakota 2 Witnesses OR Notary 23-06.5-05(2)
Ohio 2 Witnesses OR Notary 2107.03
Oklahoma 2 Witnesses § 63 3101.4(A)
Oregon 2 Witnesses OR Notary 127.515(2)
Pennsylvania 2 Witnesses § 54-5442(b)(2)
Rhode Island 2 Witnesses § 23-4.11-3(a)
South Carolina 2 Witnesses § 44-77-40(2)
South Dakota 2 Witnesses § 34-12D-2
Tennessee 2 Witnesses OR Notary § 32-11-104(a)
Texas 2 Witnesses § 166.032(b)
Utah 1 Witness § 75-2a-107(c)
Vermont 2+ Witnesses § 9703(b)
Virginia 2 Witnesses § 54.1-2983
Washington 2 Witnesses OR Notary RCW 70.122.030(1)
West Virginia 2+ Witnesses § 16-30-4(a)(4)
Wisconsin 2 Witnesses § 154.03(1)
Wyoming 2+ Witnesses OR Notary § 35-22-403(b)

Sample

Download: PDF, Word (.docx), OpenDocument


How to Write

Download: PDF, Word (.docx), OpenDocument

This is a general guide to completing an advance directive document; the Advance Directive in the principal’s state of residence should always be used.

Colors:

  • Red – Required
  • Green – Optional

Section 1 – Living Will

Step 1 – Identifying the Principal

On the first (1st) page of the document, the principal will need to enter the following information:

  1. The current date
  2. Full name
  3. Street address (apt # included, if applicable)
  4. City
  5. County
  6. State
  7. Last four (4) digits of SSN

Step 2 – Life Support

Initial AND check any of the five (5) options presented. The 5th line can be used for specifying a type of quality of life not specified on the form. This whole section is optional; the principal is not required to select quality of life treatments.

Step 3 – Intravenous Food + Water

If the principal would like to kept alive by means of intravenous food and water (through a tube/needle), they should initial AND check the first option. If they would not like to be treated artificially, they should choose the second option. Only ONE (1) of the two (2) options listed should be selected.

Step 4 – Life-Sustaining Treatment

In the event of a medical emergency in which a medical professional states intervention is necessary to keep the principal alive, they will usually administer one (1) or all of the treatments listed in this section. The principal will need to check AND initial any of the five (5) means of treatment that they DO NOT want to receive should this situation arise.

Step 5 – End-of-Life Wishes

If the principal has any end-of-life requests, these can be included on the lines provided. An example could be “I would like to be brought home from the hospital to live out my final moments.”

If the principal runs out of space, they can attach a supplemental form, title it (e.g., “Appendix A”), and write the name of the additional document on one of the lines in section C.

Section 2 – Medical Power of Attorney

Step 6 – Agent Assignment

The agent is the individual that will represent the principal. They will inform doctors of the principal’s wishes and see that they are taken care of in the manner that was set forth in the “Living Will” section.

The principal will need to enter the following information into the appropriate fields:

  1. Principal’s full name
  2. Agent’s full name
  3. Principal’s initials (optional)
    • If the principal wishes to grant the agent the power to admit them to inpatient psychiatric care (if ordered by a physician), the first line should be initialed. If the principal also wishes to make the form NOT revocable upon their incapacitation (unable to communicate with those around them), the second line should be initialed.
  4. Agent’s address
  5. Agent’s phone number
  6. Successor (secondary) agent name (they will have power of attorney if the primary agent cannot perform their duties)
  7. Successor agent’s address
  8. Successor agent phone number

Step 7 – Principal’s Signature

The last step for the principal is to inscribe their signature on the document. This may need to be done in the presence of witnesses and/or a Notary Public, depending on the state the principal resides in. By signing the form, the principal is stating they understand and agree with all the information contained in the form. The following information will need to be provided in this section:

  1. Signing date
  2. Principal’s signature (by hand OR via eSign)
  3. Principal’s full printed name
  4. Principal’s address
  5. Principal’s phone number

Section 3 – Witnesses and/or Notarization

Step 8 – Witness Signature(s)

If required by the state, the principal may need to have one (1) or more witnesses sign the document after witnessing the principal sign their name. The witnesses CAN sign digitally via eSign as long as they are in the same physical location as the principal. The witnesses must provide their signature, printed name, address, and phone number in the appropriate fields as shown below.

Step 9 – Notarization

Some states allow the principal to notarize their signature instead of having witnesses sign the form. Alternatively, the principal may decide to have their Advance Directive notarized IN ADDITION to witnesses to add further proof as to the validity of the document. The principal can have the document notarized online by using eSign, or by visiting a post office, library, government office, or similar institution that has notary services available.


Frequently Asked Questions

Who can get an Advance Directive?

Any individual eighteen (18) years or older may create an advance directive. For individuals under eighteen (18) years of age, their parents or legal guardians are automatically nominated as their health care agents.

What are the signing requirements?

The majority of advance directives need to be signed by the principal, a notary, and two (2) witnesses. In most cases, a nurse, doctor, parent, and beneficiaries in a patient’s last will are not allowed to be witnesses to the execution of an advance directive.

Where can I register an Advance Directive?

An advance directive may be registered either at the local or state government level, or with a third (3rd) party. Registering is free in most states, sometimes a small fee will be charged. The following four (4) sites are reliable options for online registration:

What is incapacitation?

Incapacity defined by Section 102, Subsection 5 (Page 7) of the Uniform Power of Attorney Act:

“Incapacity” means inability of an individual to manage property or business affairs because the individual: (A) has an impairment in the ability to receive and evaluate information or make or communicate decisions even with the use of technological assistance; or (B) is: (i) missing;  (ii) detained, including incarcerated in a penal system; or (iii) outside the United States and unable to return.

Can a family member override an Advance Directive?

No, a family member cannot override the terms outlined in a living will unless specific instructions were given to the agent that permits them to do so.

Advance Directive vs Living Will vs Medical Power of Attorney

A living will is used for listing one’s preferences for medical treatment if they should become incapacitated (e.g., receive CPR, life support, etc.) A medical power of attorney nominates a person (the agent) to communicate one’s preferences to medical professionals.

The combination of both forms creates an advance directive, which contains instructions for treatment and nominates an agent to communicate said instructions.

Advance Directive vs Do Not Resuscitate (DNR)

An advance directive represents a patient’s medical decisions in case they cannot speak or make decisions for themselves. A do not resuscitate (DNR) informs all medical professionals NOT to perform any life-saving procedures on a patient.