Generic Living Will Template printable pdf download

Generic living will

FORM 3

PAGE 1

We have provided this generic living will form, which contains four scenarios, for your convenience. If you

also fill out the health decisions worksheet, be very careful that your instructions in the two documents

match, so that you do not create confusion for your caregivers and health care agent.

While this generic living will form meets the legal requirements of most states, it may or may not fit the

requirements of your particular state. It is very important that you use a form that meets the require-

ments of your own state. This one is adapted from the Oregon form, but many states have special forms or

special procedures for creating health care advance directives. You can find your own state’s form at www.

Even if your state’s law does not recognize the document in this report, it

will still provide important evidence of your wishes if you cannot speak for yourself. In other words, it would

serve as an advisory document, not a legal document.

Directions

You, the principal, should fill in your name, address, and contact information. Depending on whether your

state requires witnesses or notarization, or both, you must meet these rules so that the document will be valid.

After reading through each of the four scenarios, check boxes next to the options. We recommend discussing

the scenarios with your doctor, who can help you make choices that reflect your values and beliefs. Add notes

for further clarification, if you like. All scenarios assume you are unable to voice your wishes.

Requirements for witnesses or notarization

Most states require the signatures of two witnesses on a living will; some allow notarization of the document

instead. Each state has rules regarding witness disqualification (that is, who cannot serve as a witness to sign

these documents). Check your own state’s requirements, but to cover virtually all variations in state law, choose

witnesses who are at least 18 years old (19 years old in Alabama and Nebraska) and who are not

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the individual you’ve appointed as your health care agent or an alternate agent

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related to you by blood, marriage, or adoption

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your health care provider, including the owner or operator of a health, long-term care, or other residential

or community care facility serving you

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an employee of your health care provider

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financially responsible for your health care

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an employee of your life or health insurance provider

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a creditor of yours or entitled to any part of your estate under a will or codicil, by operation of law

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entitled to benefit financially in any other way as a result of your death.

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Advance Care Planning

Generic Living Will Template