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.



        Print your name on the line above

I 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.

I 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

my 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 decisions:

__________________________________________       _________________     _______________
                       (Name)                                                                              (Home)                           (Work)

If 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.

________________________________________________     ________________
                      (Signature)                                                                             (Date)

 ________________________________________________     ________________
                      (Witness)                                                                                 (Date)