Free Health Care Directive

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Health Care Directive

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Appoint someone as my Health Care Agent

Specify my health care preferences

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ADVANCE DIRECTIVE FOR HEALTH CARE

MEDICAL POWER OF ATTORNEY

DISCLOSURE STATEMENT

THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS:

Except to the extent you state otherwise, this document gives the person you name as your agent the authority to make any and all health care decisions for you in accordance with your wishes, including your religious and moral beliefs, when you are no longer capable of making these decisions yourself. Because "health care" means any treatment, service, or procedure to maintain, diagnose, or treat your physical or mental condition, your agent has the power to make a broad range of health care decisions for you. Your agent may consent, refuse to consent, or withdraw consent to medical treatment and may make decisions about withdrawing or withholding life-sustaining treatment. Your agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, or abortion. A physician must comply with your agent's instructions or allow you to be transferred to another physician.

Your agent's authority begins when your doctor certifies that you lack the competence to make health care decisions.

Your agent is obligated to follow your instructions when making decisions on your behalf. Unless you state otherwise, your agent has the same authority to make decisions about your health care as you would have had.

It is important that you discuss this document with your physician or other health care provider before you sign it to make sure that you understand the nature and range of decisions that may be made on your behalf. If you do not have a physician, you should talk with someone else who is knowledgeable about these issues and can answer your questions. You do not need a lawyer's assistance to complete this document, but if there is anything in this document that you do not understand, you should ask a lawyer to explain it to you.

The person you appoint as agent should be someone you know and trust. The person must be 18 years of age or older or a person under 18 years of age who has had the disabilities of minority removed. If you appoint your health or residential care provider (e.g., your physician or an employee of a home health agency, hospital, nursing home, or residential care home, other than a relative), that person has to choose between acting as your agent or as your health or residential care provider; the law does not permit a person to do both at the same time.

You should inform the person you appoint that you want the person to be your health care agent. You should discuss this document with your agent and your physician and give each a signed copy. You should indicate on the document itself the people and institutions who have signed copies. Your agent is not liable for health care decisions made in good faith on your behalf.

Even after you have signed this document, you have the right to make health care decisions for yourself as long as you are able to do so and treatment cannot be given to you or stopped over your objection. You have the right to revoke the authority granted to your agent by informing your agent or your health or residential care provider orally or in writing or by your execution of a subsequent medical power of attorney. Unless you state otherwise, your appointment of a spouse dissolves on divorce.

This document may not be changed or modified. If you want to make changes in the document, you must make an entirely new one.

You may wish to designate an alternate agent in the event that your agent is unwilling, unable, or ineligible to act as your agent. Any alternate agent you designate has the same authority to make health care decisions for you.

THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS SIGNED IN THE PRESENCE OF TWO COMPETENT ADULT WITNESSES. THE FOLLOWING PERSONS MAY NOT ACT AS ONE OF THE WITNESSES:

the person you have designated as your agent;
a person related to you by blood or marriage;
a person entitled to any part of your estate after your death under a will or codicil executed by you or by operation of law;
your attending physician;
an employee of your attending physician;
an employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility; or
a person who, at the time this power of attorney is executed, has a claim against any part of your estate after your death.

I have read this disclosure and I understand it.

Signature: ____________________________________

DESIGNATION OF HEALTH CARE AGENT

I, _________________________, appoint:

Name: _______________________
Address: _______________________
City: _______________________
State: The State of Texas
Phone: ______________________________

as my agent to make any and all health care decisions for me, except to the extent I state otherwise in this document. This Medical Power of Attorney takes effect if I become unable to make my own health care decisions and my physician certifies this fact in writing.

My agent is subject to no limitations other than those imposed by law or expressed herein.

In accordance with the Health Insurance Portability and Accountability Act of 1996, 42 USC 1320d ("HIPAA"), I authorize my health care agent to review and receive any information regarding my physical or mental health, including medical and hospital records.

LOCATION OF DOCUMENTS:
The original of this document is kept at:

_________________________________________________________________________

The following individuals or institutions have signed copies:

Name: _____________________________

Address: __________________________________

Phone: _______________

Name: ____________________________

Address: __________________________________

Phone: _______________

DURATION:
I understand that this power of attorney exists indefinitely from the date I execute this document unless I establish a shorter time or revoke the power of attorney. If I am unable to make health care decisions for myself when this power of attorney expires, the authority I have granted my agent continues to exist until the time I become able to make health care decisions for myself.

This power of Attorney ends on the following date: Not Applicable

The remainder of this document will be available when you have purchased a license.

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Last Updated September 16, 2024

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What is a Living Will?

A Living Will is a document in which you can specify the medical treatments you wish to receive if you become incapacitated and can’t communicate.

As such, this document helps health care workers understand when to proceed with certain treatments when you’re:

In a coma
Terminally ill or injured
In the late stages of dementia
Near the end of life

The terms of your directive are binding once you sign the document.

Is a Living Will the same as a Health Care Directive?

Generally, a Living Will and a Health Care Directive both dictate your health care preferences in the event of a medical emergency or incapacitation.

Some states use the terms Living Will and Health Care Directive interchangeably, while others use one term but not the other. The requirements for each document also vary by jurisdiction. LawDepot’s Living Will template will automatically customize your document to suit the laws in your selected location.

This document is sometimes called a Living Will because it only applies while you’re still alive. People also use the term Health Care Directive because it dictates which medical treatments and decisions you consent to. Other common names for this document include:

Advance Directive
Advance Medical Directive
Advance Decision Form
Personal Directive

In addition to your directives, LawDepot’s Living Will template allows you to grant decision-making powers to another person with a Medical Power of Attorney.

What is a Medical Power of Attorney?

A Medical Power of Attorney is a document that appoints someone to make medical decisions on your behalf. This person becomes known as your health care agent or proxy.

If you’re incapacitated, your health care agent generally has the authority to:

Consent or refuse consent to treatments (per your Living Will)
Receive/review your medical and hospital records
Sign any medical releases or health care documents

A Medical Power of Attorney is also known as a Durable Power of Attorney for Health Care. For decision-making powers over legal, financial, and other personal areas of your life, use a Power of Attorney.

Who makes decisions if there’s no Medical Power of Attorney?

Typically, laws about family, health, and safety in your jurisdiction dictate who makes health care decisions for you if you’re unable to. In some states, surrogate consent laws create a hierarchy of people (e.g., family and friends) who should be able to convey your wishes accurately.

For example, in Arizona, the first five people health care workers defer to are:

Any court-appointed guardian for making health care decisions
Your health care agent
Your spouse
Your adult child
Your domestic partner (if unmarried)

Notably, your spouse and family do not automatically have this authority if you’ve designated someone else as your health care agent. In this case, health care workers will defer to this person first and foremost.

Also, family members cannot override the directives you outlined in your Living Will. Nor can they override the decisions of your health care agent—who’s legally obligated to execute your Living Will.

Why should I create a Living Will?

Creating a Living Will gives you control when you can’t speak for yourself and saves your family from making tough choices on your behalf.

Plus, when implementing a Medical Power of Attorney, you can discuss your wishes with someone you trust before you’re incapacitated. This way, you can trust they’ll make decisions in your best interest.

Imagine your family being asked to make medical decisions on your behalf. Would they struggle to agree on the best course of action? Who might argue or anguish over making “the right choice”? Avoid this situation by writing your health care wishes down in advance.

How to write a Living Will

Use LawDepot’s printable PDF template to customize a directive that suits your needs and preferences, while also complying with the laws of your state.

Specify your desired level of care if in a terminal condition, permanent coma, or vegetative state.

Terminally ill or injured means you have an incurable condition that limits your life expectancy. A permanent coma or vegetative state is when there’s a reasonable degree of certainty that you cannot think, feel, knowingly move, or be aware of living. Often, there’s little hope for improvement.

In these cases, consider if you wish to receive:

Life Support: life-sustaining procedures that restore function to an organ through medical intervention, such as CPR, defibrillators, assisted breathing, or dialysis.
Tube feeding: continuous life support that artificially administers food and water.
Comfort care: treatments that manage symptoms, pain relief, and quality of life.

2. Provide personal details

Include your full name and address.

If you can become pregnant, consider whether you want to suspend your Health Care Directive if there’s a chance your fetus can survive.

3. If desired, appoint a health care agent

LawDepot’s Living Will template allows you to include a Medical Power of Attorney. With this form, you can appoint a representative and an alternate to act if your first choice is unavailable. If doing so, include their:

Full name
Address
Phone number
Relationship to you

4. Add any special instructions, if applicable

Consider any unique circumstances or preferences you may want to include. For example, if your religious beliefs prohibit certain health care treatments.

Remember that you cannot include any instructions unrelated to health care planning.

5. Sign the document

Depending on your state’s law, you’ll need to sign your Living Will in front of at least two witnesses, a notary public, or both. LawDepot’s Living Will template will also include a Statement of Witnesses if your state requires it. In this statement, your witnesses swear they meet the legal requirements to witness and sign the document.

Also, it’s best practice to keep a record of any copies you make. For instance, you, your health care agent (if applicable), and your family doctor should each keep a copy. It’s helpful to keep a record of who owns a copy so that you know who to contact whenever you update your health care preferences.

Free Health Care Directive

Create Your Free Health Care Directive

Health Care Directive

Create Your Health Care Directive

Create Your Health Care Directive

Your Health Care Directive

What is a Living Will?

Is a Living Will the same as a Health Care Directive?

What is a Medical Power of Attorney?

Who makes decisions if there’s no Medical Power of Attorney?

Why should I create a Living Will?

How to write a Living Will

2. Provide personal details

3. If desired, appoint a health care agent

4. Add any special instructions, if applicable

5. Sign the document

Do I need to notarize a Living Will?

How do I make changes to my Living Will?

What’s the difference between a Last Will and a Living Will?

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