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Colorado Living Will Form | Declaration as to Medical or Surgical Treatment

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The Colorado Living Will, also known as the “Declaration as to Medical or Surgical Treatment”, is a legal document whereas the Declarant (Principal) may have the right to place into writing their instructions with regard to medical procedures in the event, in future circumstances, they are unable to make decisions on their own, in advance of any unforeseen, critical medical condition that may require surgery that may or may not be beneficial to the improvement of their long-term health conditions.

Laws – § 15-18-101 to § 15-18-113

Medical Power of Attorney – A patient may elect to authorize a trusted individual (‘agent’) to make decisions on their behalf to compliment the living will.

How to Write

Step 1 – Naming of Declarant – In the first line of the form:

  • Provide the full legal name of the Declarant (Principal)

Step 2 – Review of the Terms of the Document – The Declarant (Principal) must review all of the information in the first section of the form

Step 3 – Selection of End of Life Actions – Read the following statement and initial all that apply in the lines preceding the selections:

  • In the event that the only procedure I am being provided is artificial nourishment, I direct that one of the following actions be taken:
  • a. Artificial nourishment shall not be continued when it is the only procedure being provided
  • OR
  • b. Artificial nourishment shall be continued for (enter the number of days) days when it is the only procedure being provided
  • OR
  • c. Artificial nourishment shall be continued when it is the only procedure being provided.
  • After completing this section, date the statement and selection(s) in dd/mm/yyyy format.
  • Enter Declarant’s Signature

Step 4 – Witness’ Signatures – Witnesses shall review the final  statement and complete the following:

  • Enter the Declarant’s Name
  • Enter the location where the declarant and witnesses are signing the document
  • Date the signatures in dd/mm/yyyy format

Witness 1 –

  • Signature
  • Full Physical Address

Witness 2 – 

  • Signature
  • Full Physical Address

Step 5 – Notarization – Once the notary has witnessed the signatures of all parties, he/she will be responsible to complete the remainder of the of the document. The notary will authenticate the document by affixing their signature and state seal


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