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Utah Advance Directive Form

The Utah advance directive form is a two-part health care planning document designed to ensure that proper care is administered to patients who are unable to make decisions for themselves. This form must be completed by a person who is of sound mind and capable of making their own decisions. If they become incapacitated or contract a terminal illness, their advance directive will come into effect.

The first part of the document enables the principal to appoint a health care agent to make decisions for them if they are disabled. The second part will contain the principal’s instructions to medical staff regarding what life-sustaining treatments they do and do not want to receive.

Agent’s Duties§ 75-2a-110

LawsTitle 75, Chapter 2a

Signing Requirements (§ 75-2a-107(c)) – One (1) Witness

Statutory Form§ 75-2a-117


State Definition

Statute§ 75-2a-103(2)

“Advance health care directive”:

(a) includes:

(i) a designation of an agent to make health care decisions for an adult when the adult cannot make or communicate health care decisions; or
(ii) an expression of preferences about health care decisions;

(b) may take one of the following forms:

(i) a written document, voluntarily executed by an adult in accordance with the requirements of this chapter; or
(ii) a witnessed oral statement, made in accordance with the requirements of this chapter; and

(c) does not include a life with dignity order.