Directive To Physicians (Living Will) Form printable pdf download

INFORMATION TO HELP YOU DIRECT YOUR CARE

IF YOU BECOME INCAPACITATED

VIRGINIA MASON MEDICAL CENTER ñ Seattle WA

When you are critically ill or injured, you may lose the capacity to direct your care. Two legal documents

in Washington State can help you outline your wishes for health care ahead of time: the ìDirective to

Physicians (Living Will)î and ìDurable Power of Attorney for Health Care.î

Virginia Mason provides forms of these documents, which are described below. Please remember this

information is not intended as legal advice. Any legal questions you may have should be directed to an

attorney.

WHAT IS A DIRECTIVE TO PHYSICIANS (LIVING WILL)?

The Directive to Physicians is a document in which you specify the types of care you want when you are

terminally ill and dying or when you are permanently unconscious. The advance directive may also be known

as a health care directive or living will. It is intended to direct the actions of your family and physicians.

The advance directive must be signed in the presence of two witnesses who are not related to you, are not

potential heirs, are not your doctor or doctorís employees, or employees of the health care facility in which

you reside.

Although we have not provided a form for it, you may also make a mental health directive which speci es

how treatment decisions should be made if you become unable to make sound choices due to mental illness.

WHAT IS A DURABLE POWER OF ATTORNEY FOR HEALTH CARE?

A Durable Power of Attorney for Health Care is a legal document in which you name another person (called

a health care agent) to make medical decisions for you if you lose the capacity to make informed health care

decisions for yourself. You can include special instructions about treatment you do or do not want.

Who can you appoint as a health care agent? The person you appoint as your health care agent cannot be

any of the following:

ï Your physician

ï An employee of your physician

ï An administrator, owner, or employee of a health care facility in which you reside or receive care

The Durable Power of Attorney should be dated, signed and notarized. Note: the notary signature is not

required in Washington State, but other states do require it, so notarizing is prudent in anticipation of relying

on the form while traveling out of state.

Documents

Signed copies of the Directive to Physicians and the Durable Power of Attorney for Health Care should be

retained as follows:

ï copies should be given to your health care provider and be included in your of cial medical record

ï copies should go to the person (and alternates) you have designated as your health care agent

under the Durable Power of Attorney

ï copies should go to your personal attorney, if any

ï keep copies for yourself and give copies to someone you trust, for safekeeping

*CNADVDIR*

NAME

DOB

VMMC Form 900378 (12-13)

Directive To Physicians (Living Will) Form