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Vermont Advance Directive Form

The Vermont advance directive is an extensive health planning document used to appoint a health care agent and leave instructions for medical professionals in the event of incapacitation or terminal illness. An advance directive allows a person to select an individual to act as their health care agent, state their values and goals regarding health care, convey end-of-life treatment wishes, approve organ/tissue donations, and express funeral and body disposition arrangements. For this document to be legally binding, the principal must sign in the presence of two witnesses.

Agent’s Duties§ 9711

LawsTitle 18, Chapter 231

Signing Requirements (§ 9703) – Two (2) Witnesses


State Definition

Statute§ 9701(1)

“Advance directive” means a written record executed pursuant to section 9703 of this title, which may include appointment of an agent, identification of a preferred primary care clinician, instructions on health care desires or treatment goals, an anatomical gift, disposition of remains, and funeral goods and services. The term includes documents designated under prior law as a durable power of attorney for health care or a terminal care document.


Registering

Once a person has completed a Vermont Advance Directive Form, they must complete the following steps:

Step 1 – Registration Policy and Agreement

Download the Registration Agreement form provided by the Vermont Department of Health. (Don’t forget to read the Registration Policy found on the second page of the document.)

Step 2 – Attach Advance Directive

A copy of a completed advance directive form must be attached to the registration agreement. Alternatively, an Advance Directive Locator form can be attached, which simply reveals the physical location of said advance directive so it can be retrieved when it becomes effective.

Step 3 – Mail or Fax

Mail or fax all the above-mentioned forms to:

Vermont Advance Directive Registry (VADR)
PO Box 2789
Westfield, NJ 07091-2789

OR

(Fax) 908-654-1919