Advance Medical Directive Worksheet

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ADVANCE MEDICAL DIRECTIVE WORKSHEET
¨ FOR OFFICE USE ONLY
Date:
Attorney:
Date Needed:
Reviewing Attorney:
THIS FORM MUST BE COMPLETED IN ORDER FOR THE LEGAL
ASSISTANCE
OFFICE TO PREPARE AN ADVANCED MEDICAL DIRECTIVE
An ADVANCED MEDICAL DIRECTIVE is exempt from any
requirement of form, substance, formality or recording that is provided for
advance medical directives under the laws of a State; and shall be given
the same legal effect as an advance medical directive prepared and
executed in accordance with the laws of the State concerned. You should,
however, have this document prepared for the State where you believe it is
most likely that these decisions will be made.
LIVING WILLS
HEALTH CARE POWERS OF ATTORNEY
A "Living Will" informs a doctor of your 'quality
A "Health Care Power of Attorney" allows you to
of life' decision for a natural death and allows the
appoint an agent who is authorized to make all
doctor to act on this decision. An "advance medical
health care decisions for you when your are
directive" is a written declaration (LIVING WILL)
incapacitated. This document usually includes
that sets forth directions regarding he provision,
giving your agent the power to express and
withdrawal, or withholding of life-prolonging
execute your intentions for a natural death. Your
procedures, including hydration and sustenance, for
agent will not be allowed to made medical
the declarant, whenever the declarant has a
decisions for you until a doctor certifies that you
terminal physical condition or is in a persistent
are unable to make these decision yourself (i.e.
vegetative state; or a written declaration (HEALTH
that you are incapacitated). The Health Care
CARE POWER OF ATTORNEY) that authorizes
Power of Attorney is a much broader document
another person to make health care decisions for
than a Living Will. If you desire to execute a
the declarant, under circumstances stated in the
Health Care Power of Attorney allowing natural

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