Advance Medical Directive Forms

Make your wishes for end-of-life treatment known by putting them in writing in this Personal Directive form for Northwest Territories.

• A Personal Directive allows you the opportunity to set out your wishes regarding what types of medical treatment you want or don't want, in the event that you are diagnosed with a terminal condition or are in a coma with no real chance of recovery.
• You can name someone you trust to act as your agent to give consent and make medical and personal care decisions on your behalf if you are unable to, due to incapacity or medical condition.
• The form also includes information and instructions to help you complete your Personal Directive.
• Updated 2019 to ensure compliance with the Personal Directives Act.
• This legal document should only be used in the Northwest Territories, Canada.

Make sure that your wishes are followed in the event that you become physically or mentally incapacitated, with this Nova Scotia Personal Directive form.

• A personal directive is also called an advance directive or a living will. It only becomes effective if you are determined to have lost capacity to make your own decisions.
• This form comes with information and instructions to guide you through the process.
• The form is made in compliance with the Personal Directives Act of Nova Scotia. It replaces the previous Medical Consent Act.
• The personal directive gives you the option to appoint one or more persons to act on your behalf as your delegate, to make decisions about your personal care, which includes health care, housing, lifestyle and other non-financial matters.
• You can also give end-of-life instructions on which treatments should be administered to you if you have a terminal illness or are in a permanent coma.
• Each adult member of your household can prepare a Personal Directive using the same form - no need to buy multiple copies.
• This Nova Scotia Personal Directive form is available as a downloadable MS Word form, and is easy to fill in with your personal information.

Does your doctor and your family know your wishes for end-of-life treatment in the event that you become physically or mentally incapacitated? Put it in writing with this Advance Health Care Directive form for Nunavut.

• An Advance Directive gives you an opportunity to leave instructions in writing regarding what types of medical treatment you want or don't want, in the event that you are diagnosed with a terminal condition or are in a coma with no real chance of recovery.
• If you wish, you can also name a person or persons that you would prefer to have appointed as your potential Guardian, to make medical decisions on your behalf if you become unable to do so.
• The form includes instructions to guide you through each section.
• This form is intended for use in Nunavut Territory. Each adult member of your family can use the same template - no need to buy separate copies.

Carry a copy of a DNR (Do Not Resuscitate) Confirmation Form with you if you do not wish to have CPR administered by paramedics or firefighters.

• The form must be signed by a physician, registered nurse, registered nurse in the extended class, or registered practical nurse.
• In accordance with Ontario laws, the DNR form instructs paramedics and firefighters not to administer CPR (including use of breathing tubes and resuscitation drugs).
• Palliative care (comfort care) will still be provided, including administration of oxygen, suctioning, and pain medication.
• When completed, the form will be numbered with a unique serial number.
• This form contains both English and French language versions.
• The form is issued by the Ontario Ministry of Health and Long-Term Care and the Office of the Fire Marshal.
• Available in PDF format.
• Intended to be used only in the Province of Ontario, Canada.

Be sure that your family and your doctors know your wishes for end-of-life treatment by completing this Ontario Personal Directive form.

• A Personal Directive gives you a chance to write out your wishes regarding what types of medical treatment you want or don't want, in the event that you are not able to communicate those wishes.
• If you wish, you can also appoint someone as your substitute decision maker to give consent and make medical decisions on your behalf.
• A Personal Directive is not recognized as a legal document under Ontario legislation, but it does indicate to your loved ones and your health care providers what your wishes are. However, they are not legally obligated to comply with those wishes. If you have a Power of Attorney for Personal Care, your Personal Directive will help your attorney make more informed decisions for you.

PEI residents, make sure that your wishes are followed, in the event that you are unable to give directions for treatment, with this Prince Edward Island Health Care Directive.

• A Health Care Directive (also called a living will) allows you to appoint one or more persons to act on your behalf as your proxy.
• You can give your proxy detailed instructions and set out your wishes regarding what types of medical treatment you want or don't want, in the event that you become unable to communicate those wishes due to illness or injury.
• The form includes a Declaration of Incapacity form, as well as information and instructions to help you complete the documents.
• This is a downloadable Health Care Directive form in MS Word format. It is intended for use only in the Province of Prince Edward Island.

If you were terminally ill and unable to communicate, would your family know your wishes regarding medical treatment? Make an Advance Health Care Directive and be sure your instructions are followed.

• This Advance Directive package is for Saskatchewan residents.
• With this form (also called a Living Will), you can appoint someone close to you to act as your proxy, to make decisions and give instructions to your physician when you aren't able to, because of illness or injury.
• You can use the Directive to set out your wishes regarding what types of medical treatment you want or don't want.
• This package contains the following forms for Saskatchewan:
  • Advance Health Care Directive,
  • Declaration of Incapacity by Two Physicians form,
  • information and instructions to help you complete the form.

This Saskatchewan Advance Health Care Directive Package is a downloadable MS Word file. You can use the template more than once. For instance, both you and your spouse or partner can prepare a Directive using the same package. No need to buy multiple copies.

• admission to a mental health treatment facility,
• use of psychotropic medications,
• electro-convulsive (shock) therapy,
• use of seclusion or restraint as a response to violent or destructive behavior,
• special instructions concerning personal matters in the event that you become unable to communicate your wishes.

Texas residents, make certain that your wishes regarding medical treatment are known by your doctor and your family by making an Advance Medical Directive.

• This Advance Medical Directive Forms Package for Texas contains 20 pages of forms, including:
  • an explanation of what an advance directive is;
  • instructions on preparing and completing an advance directive;
  • a Directive to Physicians and Family or Surrogates (also known as a Living Will) which sets out your instructions regarding life-sustaining procedures and treatment;
  • a Medical Power of Attorney appointing an agent to make health care decisions for you;
  • a disclosure statement of information specific to Texas law.
• These easy-to-use Texas Advance Medical Directive Forms are provided in MS Word format.
• They can be used by more than one person just by filling in the appropriate information in a separate copy.
• Intended to be used only in the State of Texas.

Make an Advance Health Care Directive with this package of forms for residents of Virginia.

• This package of forms contains:
  • information about the purpose and intent of an advance directive,
  • instructions on preparing and completing the forms,
  • Virginia Advance Directive for Health Care which allows you to:
    • appoint an agent to make health care decisions for you if you become incapacitated,
    • set out your instructions regarding life-sustaining procedures and other future health care decisions, and
    • give instructions about organ and tissue donations, if you wish to do so.
• Making an Advance Directive can help to ensure that your family and your doctor know what your wishes are regarding medical treatment and life support if you are unable to communicate or make your own decisions.
• These easy-to-use Advance Directive forms are provided in MS Word format, and can be used by more than one person in your household.
• Intended to be used only in the Commonwealth of Virginia.