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Forms 1- 20 of 47 Available for 'Living Wills'

Pour over Will  

I. I, _____ (Complete Name), currently residing at ______ (Address) being of sound mind and in the contemplation of the certainty of death, do hereby declare this instrument to be my last will and testament. V. I hereby appoint _____ (Complete Name and Address) to act as the executor of this will, to serve without bond. Should ...

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Declaration of A Desire for A Natural Death  

__ My physician may withhold or discontinue extraordinary means only. __ In addition to withholding or discontinuing extraordinary means if such means are necessary, my physician may withhold or discontinue either artificial nutrition or hydration, or both. I also state that I am not the declarant's attending physician or an employee of the declarant's attending physician, or an employee of a health care facility in which the declarant is a patient or an employee of a nursing home or ...

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Appointment of Guardian  

I appoint ____ (Name and Address) to act as guardian of the minor child(ren) stated above upon my inability to so act. Should _____ be unable or unwilling to serve, I appoint ____ (Name and Address) to act as the guardian of the minor children in the place of ____. In the event that I am the custodian of any property for the minor children under the ...

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Texas - Directive to Physicians  

5. I understand the full import of this directive and I am emotionally and mentally competent to make this directive. I am not the attending physician of the declarant or an employee of the attending physician. Furthermore, if I am an employee of a health facility in which the declarant is a patient, I am not involved in providing direct patient care to the declarant and am not directly involved in the financial affairs of the health facility.

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Georgia - Living Will  

Additional witness required when living will is signed in a hospital or skilled nursing facility. I hereby witness this living will and attest that I believe the declarant to be of sound mind and to have made this living will willingly and voluntarily. Medical director of skilled nursing facility or staff physician not participating in care of the patient or chief of the hospital medical staff or staff physician or hospital designee not participating in care of the patient.

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California - Declaration  

If I should have an incurable and irreversible condition that has been diagnosed by two physicians and that will result in my death within a relatively short time without the administration of life-sustaining treatment or has produced an irreversible coma or persistent vegetative state, and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician, pursuant to the Natural Death Act of California, to withhold or withdraw treatment, including ...

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Florida - Designation of Health Care Surrogate  

I fully understand that this designation will permit my designee to make health care decisions and to provide, withhold, or withdraw consent on my behalf; to apply for public benefits to defray the cost of health care; and to authorize my admission to or transfer from a health care facility. I further affirm that this designation is not being made as a condition of treatment or admission to a health care facility. I will notify and send a copy of this document to the following persons other ...

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Florida - Living Will  

If at any time I have a terminal condition and if my attending or treating physician and another consulting physician have determined that there is no medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the administration of medication or the performance of any medical ...

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Virginia - Advance Medical Directive  

OPTION: APPOINTMENT OF AGENT (CROSS THROUGH IF YOU DO NOT WANT TO APPOINT AN AGENT TO MAKE HEALTH CARE DECISIONS FOR YOU.) I hereby appoint ___(primary agent), of ___(address and telephone number), as my agent to make health care decisions on my behalf as authorized in this document. I hereby grant to my agent, named above, full power and authority to make health care decisions on my behalf as described below whenever I have been determined to be incapable of making an informed ...

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With Appointment of Proxy  

If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician, cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I appoint ___ or, if he or she is not reasonably available or is unwilling to serve, ___, to make decisions on my behalf regarding withholding or withdrawal of treatment that only prolongs the ...

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Pennsylvania - Declaration  

This declaration reflects my firm and settled commitment to refuse life-sustaining treatment under the circumstances indicated below. I direct that treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing life-sustaining treatment. I realize that if I do not specifically indicate my preference regarding any of the forms of treatment listed above, I may receive that form of treatment.

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Tennessee - Living Will  

___ Authorize the withholding or withdrawal of artificially provided food, water or other nourishment or fluids. ___ Desire to donate my organs and/or tissues for transplantation. ___ Desire to donate my ___(Insert specific organs and/or tissues for transplantation).

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Arizona - Living Will  

Some general statements concerning your health care options are outlined below. You can also write your own statement concerning life-sustaining treatment and other matters relating to your health care. ___ 1. If I have a terminal condition I do not want my life to be prolonged and I do not want life-sustaining treatment, beyond comfort care, that would serve only to artificially delay the moment of my death.

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Illinois - Declaration  

I, ___, being of sound mind, willfully and voluntarily make known my desires that my moment of death shall not be artificially postponed. I saw the declarant sign the declaration in my presence (or the declarant acknowledged in my presence that he or she had signed the declaration) and I signed the declaration as a witness in the presence of the declarant. I did not sign the declarant's signature above for or at the direction of the declarant.

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Maryland - Living Will  

If I am not able to make an informed decision regarding my health care, I direct my health care providers to follow my instructions as set forth below. ___ I direct that my life not be extended by life-sustaining procedures, including the administration of nutrition and hydration artificially. ___ I direct that my life not be extended by life-sustaining procedures, except that, if I am unable to take food by mouth, I wish to receive nutrition and hydration artificially.

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Missouri - Declaration  

I have the primary right to make my own decisions concerning treatment that might unduly prolong the dying process. If I should have a terminal condition it is my desire that my dying not be prolonged by administration of death-prolonging procedures. If my condition is terminal and I am unable to participate in decisions regarding my medical treatment, I direct my attending physician to withhold or withdraw medical procedures that merely prolong the dying process and are not necessary to my...

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West Virginia - Living Will  

SPECIAL DIRECTIVES OR LIMITATIONS ON THIS DECLARATION: (If none, write "none".) I did not sign the declarant's signature above for or at the direction of the declarant. I am not the declarant's attending physician or the declarant's health care representative, proxy or successor health care representative under a medical power of attorney.

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Minnesota - Health Care Living Will  

This document gives your health care providers or your designated proxy the power and guidance to make health care decisions according to your wishes when you are in a terminal condition and cannot do so. If you name a proxy in this document and that person agrees to serve as your proxy, that person has a duty to act consistently with your wishes. If you do not name a proxy, your health care providers have a duty to act consistently with your instructions or tell you that they are unwilling...

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Nevada - Declaration  

(If the person or persons I have so appointed are not reasonably available or are unwilling to serve, I direct my attending physician, pursuant to those sections, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain.) Withholding or withdrawal of artificial nutrition and hydration may result in death by starvation or dehydration. Initial this box if you want to receive or continue receiving artificial nutrition and...

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Utah - Special Power of Attorney  

I understand that "life-sustaining procedures" do not include the administration of medication or sustenance, or the performance of any medical procedure deemed necessary to provide comfort care, or to alleviate pain, unless my attorney-in-fact specifies these procedures be considered life-sustaining. This power of attorney shall be and remain in effect from the time my attending physician certifies that I have incurred a physical or mental condition rendering me unable to give current

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