Living Will Template

Printable blank form for free download

Living Will template

Living Will
Living Will

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Download this Living Will form for your personal use. It is a free printable Living Will template.

Is the living will the same thing as a will?

Many make the assumption that a living will is exactly the same thing as a will, but this is not the truth. A living will is also known as an Advanced Medical Directive and it is a document that is created in order to make the wishes of a person clear in the event that he/she becomes incapacitated and is not able to convey personal wishes. To put it really simply, this is a document that expresses the personal wishes in the event that the person is affected by a certain situation in which he/she will not be able to communicate them anymore.
The living will names a person that will receive Medical Power of Attorney. This means that a person can act in the capacity of the named person who made the living will and will gain private medical information whenever needed and can act on this. This is important because the healthcare providers are not allowed to disclose medical information to anyone that is not authorized in writing by the patient. This includes children, spouses and even parents.
A living will has the biggest advantage of making it really easy to avoid competency hearings in the event that the patient is hit by an incapacitating illness or accident. All the feelings of the person making it will be recorded and this is extremely important in the event of having to deal with medical life-prolonging methods when there is no chance to regain normal life quality.
Simply put, this is a legal document that will tell everyone whether or not you want to be kept alive or not in the event that a serious situation appears.

Living Will template:

LIVING WILL: Directive to physicians
describing the patient’s desire that life-sustaining
procedures are not used to artificially prolong his
life under described circumstances

LIVING WILL DIRECTIVE TO PHYSICIANS

Directive made and executed by _________[name], of _________________[address], _________[state], on _________[date].
I, _________, being of sound mind, willfully and voluntarily make known my desire that my life shall not be artificially prolonged under the circumstances set forth below, and do hereby declare:
1. If at any time I should have an incurable condition caused by injury, disease, or illness certified to be a terminal condition by two physicians, and where the application of life-sustaining procedures would serve only to artificially prolong the moment of my
death, and where my attending physician determines that my death is imminent whether or not life-sustaining procedures are utilized, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally.
2. In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this directive shall be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal.
3. _________[If applicable, add: If I have been diagnosed as pregnant and that diagnosis is known to my physician, this directive shall have no force or effect during the course of my pregnancy.]
4. I have been diagnosed and notified at least _________ days ago as having a terminal condition by _________, M.D., whose address is _________, and whose telephone number is _________. I understand that if I have not filled in the physician’s name and address, it shall be presumed that I did not have a terminal condition
when I executed this directive.
5. This directive shall have no force or effect _________ years from the date filled in above.
6. I understand the full import of this directive, and I am emotionally and mentally competent to make this directive.
7. I understand that I may revoke this directive at any time.

[Signature]
ATTESTATION CLAUSE
On _________[date], _________[name], known to us to be the person whose signature appears at the end of the above directive, declared to us, the undersigned, that the above directive, consisting of _________ pages, including the page on which we have signed as witnesses, was _________[his or her] directive. _________[He or She] then signed the directive in our presence and, at _________[his or her] request, in _________[his or her] presence and in the presence
of each other, we now sign our names as witnesses. _________[Name] declarant has been personally known to us and we believe _________[him or her] to be of sound mind. We are not related to _________[name] by blood or marriage, nor would we be entitled to
any part of _________[name's] estate on _________[name's] death, nor are we the attending physicians of _________[name] or an employee of the attending physician or a health facility in which ________[name] is a patient, or a patient in the health care facility in which _________[name] is a patient, or any person who has a claim against any part of the estate of the _________[name] on _________[name's] death.
residing at [Signature] [Street, city, state] residing at Signature] [Street, city, state] residing at [Signature] [Street, city, state]

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2 Responses to Living Will template

  1. angela says:

    need will template

  2. Pat says:

    Thank you for being exactly as stated…FREE. Refreshing, and ever so helpful.

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