Printable Advance Directive Form (Word)

An advance directive form is a legally and ethically binding document used by the people (principals) to state that their medical and end-of-life treatment decisions will make by someone on their behalf when they become severe ill.

What to include in an advance directive form?

An advance directive form consists of four separate documents. They are used to provide predetermined directives or transfer decision-making authority. These documents are the following;

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  • Medical power of attorney: when you become terminally ill or incapacitated and cannot communicate your wishes, then this allows someone health care agent) to make medical/healthcare decisions on your behalf.
  • Living will: it states the type of medical wishes/treatments that the individuals would and would not want to receive when they can’t communicate.
  • POLST (Physician Orders for Life-Sustaining Treatment)
  • DNR (Do Not Resuscitate Order)

Hence, an advance directive form smoothens the whole process for the patient and medical staff as a collective of these documents. In decision makers, the family members are generally go-to-stand.

How to get an advance directive?

Here are steps to follow for getting an advance directive;

Selection of an agent

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At first, you have to choose an agent (stand-in-decision maker) to make health care decisions for you.

Outline the powers

Here, you should identify how much power/authority one is willing to hand over to the agent. An agent’s power may vary from one condition to another.

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End-of-life options

You should include how you wish to be handled to get to an incurable state when you assign the agent powers. A principal, under this section, can direct medical personnel not to perform life support assistance procedures.

Signatures

Signing to validate the document is the next step. The principal’s state of residency laws govern the signing requirements. As a requirement, an advance directive has to sign by the principal, notary public, two witnesses, or both.

Register the directive

When all parties have signed, it is compulsory to register it to a State Registry or any other National Organization. You may also like Codicil To Will Form.

How to fill out an advance directive form?

An advance directive consists of the following sections;

Medical power of attorney

It is the first section of the directive and has the following sub-categories;

  • Power of attorney status: this section states that whether the principal wishes to use a medical power of attorney or not.
  • Principal information: your personal information is the second step to outline. Here, you have to state the principal name and address.

Medical attorney-in-fact information

The agent’s information should be included in this section such as his/her name, address, and phone number.

Alternate agent information

You can select to include a second agent as a precaution. In a statement, the information like alternate agent’s name, address, and phone number should be appeared.

Living will

This section addresses end-of-life treatment preferences. It should also include a living will status. A living will outline the principal’s directives and preferences.

Principal execution

The principal must declare that they issued the directions outlined in the document for an Advance Directive (Declarant) to issue directives to medical personnel. Include the following information here;

  • Signatures and signature date
  • Principal name (official)
  • Principal address(address, city, state, zip code)
  • Witnesses (name, signatures, and signature dates)

Notary acknowledgment

The notary public reviews the document and checks the witnesses’ confirmation statements when the directive is being notarized. After that, at the bottom, he or she outlines their name, signatures, and date of signing.

Free Printable Advance Directive Form

printable advance directive form
Details
File Format
Word (doc, docx)
Size: (20 KB)

Conclusion:

In conclusion, an advance directive form should contain specific instructions. In the directive, build good communication between you, your agent, and health care providers. A copy of the document after completion should be distributed among the stand-in-decision maker, alternate agent, and doctor.

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