These forms vary with each state! Check with a specialized Elder Care Attorney in your state.
There is more to "advance care planning" than completing legally valid documents. Completing the documents is perhaps the easiest part of an effective care planning process. The goal of this web site is to help you complete this process. If you already have completed a directive, chances are your treatment instructions are too vague to be of much help should anyone ever need to rely on them. Use this site to ONLY to review your current advance care plans and documents.
WILL & HEALTH CARE POWER OF ATTORNEY of
Print your name on the line above
want this health care document to be in effect if I cannot make my own
health care decisions. I understand I might become unable to make decisions
but later recover this ability. I also understand that even when I cannot
make a particular health care decision, I still might be able to make
others. When I can make my own decisions, I want to do so. When I cannot
make a decision, I want health care decisions to be made for me by my health
care agent, if I have one. If I do not appoint an agent or none that I
appoint is available and willing to act, I want anyone who is authorized by
law to make health care decisions for me to follow this document. Even if I
cannot make my own health care decisions, I want my physician and my health
care agent, if I appoint
one, to talk to me honestly about my condition and treatment if they think I
might understand. Should my
attending physician and my agent, if I have one, disagree about whether I
can make a decision, then my agent may have me examined by another
physician, whose decision I want to govern.
If I have no agent, then my physician shall make this determination.
intend that this document apply whether or not I have a terminal condition
when any question arises about relying on it. I
also want this document to remain in effect after my death, for autopsy,
organ donation, use of
body for medical research, and for my agent to arrange for the disposition
of my remains, if I authorize those below.
I appoint as my health care
agent to make health care decisions for me, if I cannot make such
__________________________________________ _________________ _______________
(Name) (Home) (Work)
my agent is unavailable or unwilling to serve, or if my agent is a spouse
from whom I am separated, then I name this alternate
health care agent:
__________________________________________ _________________ ________________
(Name) (Home) (Work)
I intend that the alternate act only while my first agent is unavailable. I grant my agent complete authority to make decisions for me about my health care. This includes: (a) consenting, refusing consent, and withdrawing consent already given, for medical treatment recommended by my physicians, including life-sustaining treatments; (b) requesting medical treatments; (c) access to my medical records and information; (d) employing and dismissing health care.