Nebraska Advance Directive Form

Nebraska Advance Directive Form

Last updated September 29th, 2021

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A Nebraska advance directive is a two-part medical planning document that enables the principal (individual drafting the form) to inform health care professionals of the life-sustaining treatments they want administered and to select an attorney-in-fact to represent their health care wishes. The appointment of the attorney-in-fact is made through the power of attorney section, and the directions for physicians are provided through a living will (or “declaration” as it’s called in Nebraska).

The living will is only applicable while the principal is close to death, while the medical power of attorney comes into effect should the principal lose the capacity to make informed decisions on their own. Whether signed in conjunction or separately, both forms must be executed when the principal is of sound mind.

Agent’s Duties§ 30-3417

Laws§§ 20-401 – 20-416 (Rights of the Terminally Ill Act) & §§ 30-3401 – 30-3432

Signing Requirements (§ 20-404(1) & § 30-3404(5)) – Two (2) Witnesses or Notary Public

Statutory Form§ 20-404(2) (Living Will); § 30-3408 (Power of Attorney)

State Definition

Statute§ 30-603(2)

Advance health care directive means an individual instruction under the Health Care Surrogacy Act, a declaration executed in accordance with the Rights of the Terminally Ill Act, or a power of attorney for health care;

Related Forms

Living Will – Used to inform physicians and nurses under what circumstances they should withhold life-sustaining treatments and procedures.

Download: PDF


Medical Power of Attorney – Used to select an attorney-in-fact to represent the patient when incapacitated.

Download: PDF