Living Will La

Download a blank fillable Living Will La in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Living Will La with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Living Will
(Advance Medical Directive)
STATE OF LOUISIANA
PARISH OF _______________________________
I, ____________________________________________, being of sound mind, willfully and voluntarily make
known my desire that my dying shall not be artificially prolonged under the circumstances set forth below
and do hereby declare:
1. If all of the following conditions are present, I state that the procedures checked “NO” in Paragraph 2
below should be withheld or stopped and that I should be allowed to die naturally with only the giving of
medication or the doing of any medical procedure that is necessary to provide me with comfort care:
a. I have an incurable injury, disease or illness or I am in a continual deep comatose state with no
reasonable chance of getting well; and
b. I have been personally examined by two physicians (at least one of whom shall be my treating
physician) and both physicians certify in writing:
1. That my condition is terminal, irreversible and will likely cause my death in the near
future, whether or not life-sustaining procedures are used and
2. Application of the procedures would only artificially put off the dying process, or
3. That I am in a continual deep comatose state with no reasonable chance of ever
getting well.
2. I make the following directions concerning these procedures. Checking YES means I want the treatment.
Checking NO means I do not want the treatment.
YES
NO
____
____
Cardiopulmonary Resuscitation - using drugs and electric shock to keep
my heart beating and helping me to breathe
Mechanical Breathing - ventilation; using a machine to help me breathe
____
____
____
____
Major Surgery - such as removing my gall bladder or part of my intestines
Kidney Dialysis - using machines to clean my blood
____
____
____
____
Chemotherapy - using drugs to fight cancer
Invasive Diagnostic Tests - such as using a tube to look into my stomach
____
____
____
____
Artificial Nutrition and Hydration - giving me food and fluid through a
tube in my veins, nose or stomach
____
____
Blood or Blood Products - such as giving me a transfusion
Antibiotics - using drugs to fight infection
____
____
____
____
Simple Diagnostic Tests - such as blood tests or x-rays
Pain Medications - even if they make me sleepy or indirectly shorten my life
____
____

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2