Advance Directive Form (Medical POA + Living Will)

An advance directive allows a person (“principal”) to choose someone else (“agent”) to make health care decisions on their behalf and to create end-of-life treatment instructions. To complete, the form must be signed per state law, which often requires two witnesses or a notary public.

Once signed, the agent must present the advance directive to medical at each occurrence it is used.

If the principal (the patient) is already incapacitated, the family will be required to obtain guardianship rights from the local court in order to make the patient’s medical decisions. In most circumstances, a hospital will allow the spouse or family member to act as the agent by default (although this may depend on local and state laws).

This is often referred to as the medical power of attorney portion that requires the principal to select an agent to represent their healthcare decisions. The agent may ONLY act if the principal cannot make decisions for themselves due to being incapacitated. The agent should understand the wishes of the principal and always keep their best interests in mind when making decisions.

• Second Agent – The principal is able to select a second agent to help in case the original agent is not able to perform. However, decision-making powers cannot be shared.

The principal will have to decide how much power to give the agent.

This mainly consists of:

• Electing to have the powers begin immediately or upon the principal’s incapacitation;
• Deciding to prolong the principal’s life as long as possible (even if there is no possible cure); and
• Selecting any post-death responsibilities (ordering an autopsy, where the remains are kept, etc.).

Any other powers should be mentioned to the agent verbally.

This is for the living will portion that allows the principal to select their plans if they should become in a vegetative state or uncurable situation. Under such an event, the principal can choose to stop any life support assistance such as halting breathing machines, food, or water intravenously (through an IV).

Do Not Resuscitate (DNR) – Used to inform medical personnel to not perform CPR or other life-saving procedures in the event that the principal’s heart stops beating or if they are not breathing.

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.

A notary can be found online, at a local bank, or using a notary service.

It’s best to store an advance directive in an easily accessible place in the event of an emergency. It’s common to record it with a state registry or a national organization. Wherever the advance directive is stored, the location should be recorded in a Wallet Card and kept on the principal at all times.

An advance directive may be registered in either the principal’s state of residence or in a national registry (see below).

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

• JoinCake – No fee
• U.S. Registry – $59.95 per five years ($25 for an additional five years)
• Everplans – $75 a year