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Alabama Advance Directive Form

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An Alabama advance directive allows an individual to select someone else to make health care decisions on their behalf and to decide life-ending treatment options. This is a form primarily used for those in riskier health situations and the elderly. After signing, it should be kept in a safe and accessible place in the event of an emergency.

Table of Contents

Laws

Statute – § 22-8A-4

Signing Requirements (§ 22-8A-4(c)(4)) – Two (2) witnesses of at least 19 years old and can’t be the agent or related to the principal by blood, marriage, or someone entitled to any portion of the principal’s estate or the person paying for the principal’s medical care.

State Definition (§ 22-8A-3(3)) – “A writing executed in accordance with Section 22-8A-4 which may include a living will, the appointment of a health care proxy, or both such living will and appointment of a health care proxy.”

Versions (5)


 

Alabama Hospital Association Advance Directive

Download: Adobe PDF

 

 

 


 

Baptist First Advance Directive

Download: Adobe PDF

 

 

 


 

Homestead Hospice Advance Directive

Download: Adobe PDF

 

 

 


 

Huntsville Hospital Advance Directive

Download: Adobe PDF

 

 

 


 

Spanish (Español) Advance Directive

Download: Adobe PDF

 

 

 


How to Write

Download: English (Adobe PDF), Español (Adobe PDF)

1 – Acquire the “Alabama Advance Directive | Living Will & Power of Attorney” Form

You may obtain this form directly from this site as a PDF or a Word file. Locate the buttons labeled “PDF” and “Word” on the right. Download the version you prefer working with.

2 – Provide Basic Information

Begin by entering the following in Section 1. Living Will:

  • Name of principal 

Initial if you

  • Would like to receive life-sustaining treatment if you are terminally ill or injured; 
  • Would like food and water provided through a tube if terminally ill or injured;

List any other directions you would like done in the chance something happens to your health 

  • If none initial the line that states “No, I do not have any other directions.”

3 – Naming an Agent

In Section 2., titled ‘If I need someone to speak for me’, you must enter the following:

Initial if:

  • The first line if you do not want to name a health care proxy or the second line if you do not want a health care proxy

If you elected to have a proxy enter their name, relationship to you, full address, and day-time/night-time phone number. 

In addition, if you would like a second (2nd) agent you may enter the same information on the next set of fields.

4 – Empowering the Agent

Under the ‘Instructions for Proxy’ heading you will need to make decisions on how much power your agent will have by following the questions below;

Initialing the following “yes” or “no” question:

  • Would you like your agent to make decisions based on whether to give you food or not through an IV?

Place your initials by one of the following questions:

  • You would like the agent to follow only directions listed
  • You would like the agent to make decisions based on what is written on the form and not on the form
  • You would like the agent to make any and all final decisions even though it could be something different from what is listed on this document

5 – Identify a Party for Life-Sustaining Consultations

In Section 3, Things listed on this form are what I want, list the individuals that the principal would like the doctor on site to talk about the good and bad points of no longer receiving life-sustaining treatment or food and water through a tube and IV.

6 – Principal Signature

On the signature areas the principal, health care proxy, and at least two (2) witnesses are required to authorize the form. Once complete the form should be given to the principal’s primary care physician and distributed to all participants in the document.

The first Witness listed for this Signing must provide his or her Printed Name, Signature, and Current Date

The second Witness listed for this Signing must also Print his or her Name, Sign his or her Name, and supply the current Date

7 – Health Care Proxy Acknowledgment

Locate the “Signature of Proxy” section. The first choice for the Principal’s Health Care Proxy must Print and Sign his or her name and provide a Signature Date in the Health Care Proxy Acknowledgment Statement

The second choice(if applicable) for the Principal’s Health Care Proxy must also Print and Sign his or her Name as well as provide a Signature Date. This must be done in the “Signature of Second Choice for Proxy.”

Resources

Related Forms


Durable Power of Attorney

Download: Adobe PDF

 

 

 


Last Will and Testament

Download: Adobe PDF, MS Word, OpenDocument


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