Connecticut Advance Directive Form

Connecticut Advance Directive Form

Last updated September 29th, 2021

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The Connecticut advance directive form allows individuals to prepare for palliative and end-of-life care by appointing a health care representative and recording instructions regarding medical treatments. The document addresses life-sustaining treatments such as artificial nutrition, hydration, and respiration, as well as life-saving techniques like CPR. The health care representative is a trusted individual who will become active if the principal is incapacitated and have the right to make health care decisions on their behalf.

Agent’s Duties§ 19a-580e

LawsChapter 368w (Removal of Life Support Systems and Medical Orders for Life-Sustaining Treatment)

Signing Requirements (§ 19a-575a) – Two (2) Witnesses

Statutory Form§ 19a-575a

State Definition

Statute – § 19a-570(1)

“Advance health care directive” or “advance directive” means a writing executed in accordance with the provisions of this chapter, including, but not limited to, a living will, or an appointment of health care representative, or both;


Laws – § 19a-578(b), § 19a-575a

If the principal gives an advance directive to their health care provider, it will be made a part of the declarant’s medical record. The provider is also required to record any oral instructions given by the principal. Furthermore, if the witnesses are requested to acknowledge their signatures before a notary public, they must testify in court if the advance directive is called into question.