Advance Directive Form

A family member or spouse must obtain guardianship rights if the principal is already incapacitated (i.e., cannot make decisions for themselves due to dementia or mental disability).

This can be obtained from a local court. Usually, a hospital will allow a spouse or close family member to act as the agent by default if no one else is available.

This is often referred to as the medical power of attorney portion, which requires the principal to select an agent to represent them in their healthcare decisions.

The agent may only act on behalf of the principal in a medical power of attorney if they cannot make decisions for themselves. The agent should understand the wishes of the principal and always keep their best interests in mind when making decisions.

The principal will have to decide how much power to give the agent, such as:

1. Immediate or Springing: Electing to have the powers begin immediately or upon the principal’s incapacitation;
2. End-of-Life Treatments: Deciding to prolong the patient’s life as long as possible (even if there is no possible cure); and
3. Post-Death: Selecting any post-death responsibilities (e.g., ordering an autopsy, where the remains are kept, etc.).

Any other powers should be mentioned verbally to the agent.

For the living will section, this allows the principal to select their end-of-life care option if they should become in an incurable situation.

The principal can choose to stop any life support assistance, such as stopping breathing and feeding machines.

Depending on the signing laws in your state, an advance directive must be signed with a notary public, two witnesses, or both. If given the choice, it’s recommended to have the document notarized.

It’s best to store an advance directive in an easily accessible place in the event of an emergency.

Recording it with a state registry or a national organization is recommended.

Wherever the advance directive is stored, the location should be recorded in a Wallet Card and kept on the principal at all times.

State Registries (Note: Not every state has a registry.)

• Alaska^[1] – Donor Registry
• Arizona^[2] – Online Registry
• California^[3] – Registration Form
• Idaho^[4] – Online Registry 
• Louisiana^[5] – Instructions
• Montana^[6] – End-of-Life Registry
• Nevada – Registration Form
• North Carolina – Registration Form
• Vermont – Registration Form
• Virginia – Online Registration
• West Virginia^[7] – Registration Form

National Registries

• U.S. Registry – $59.95 per five years ($25 for an additional five years)
• Everplans – $75 a year