New Jersey Advance Directive For Health Care (Living Will) (Page 2 of 7) in pdf

New Jersey Advance Directive For Health Care (Living Will) Page 2

provides you with a legal document that enable your to appoint a primary representative and

an alternate health care representative authorized to make decisions regarding your health

care and treatments consistent with your wishes as expressed in the instruction directive.

Please note that you should discuss your health care wishes with your selected

representatives and that they should consent to serve as your proxies.

This document can be completed by dating the section that follows the sentence: “I sign this

document knowingly and after careful deliberation” this day, month and year and by signing

your name and printing your address.

Your signature must be done in front of two witnesses OR a notary. It does not require both.

The hospital can usually provide a notary during week day hours. If you are using

witnesses, they cannot be listed in the document. They can be other family members,

neighbors or friends.

When you have completed your Advance Directive make several copies. Keep the original

document in a safe but easily accessible place and tell others where you have it stored. DO

NOT KEEP YOUR ADVANCE DIRECTIVE IN A SAFE DEPOSIT BOX and have it

readily available upon admission to a hospital or nursing facility. Give copies of your

Advance Directive to the individuals you have chosen to be your Health Care Representative

and Alternate Health Care Representative. You may also give copies of your Advance to

your doctor, your family, clergy and to anyone who might be involved with your health care.

New Jersey Advance Directive For Health Care (Living Will) Page 2