United States Advance Directive Forms

Make an Advance Health Care Directive with this package of forms for North Dakota.

• This package contains the following items:
  • an explanation of what an advance directive is.
  • instructions on preparing and completing an advance directive.
  • a Declaration Relating to Use of Life-Prolonging Treatment setting out your wishes regarding life sustaining procedures.
  • a Durable Power of Attorney for Health Care appointing an agent to make health care decisions for you.
• Making an Advance Directive will 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 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 State of North Dakota.

• 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.

Make a Health Care Directive and a Durable Power of Attorney for Health Care with this package of downloadable forms for the State of Washington.

• The package of forms contains:
  • Durable Power of Attorney for Health Care (DPOAHC),
  • Health Care Directive,
  • Instructions and information to help you complete the forms.
• 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.
• This package of forms is provided by End of Life Washington, in PDF format.
• Intended to be used only in the State of Washington.

Set out your wishes for life-sustaining treatment and appoint someone as your medical decision maker with Advance Medical Directive Package for West Virginia residents.

• This West Virginia Advance Medical Directive Forms Package contains:
  • an explanation of what an advance directive is,
  • instructions on preparing and completing your advance directive,
  • a Combined Medical Power of Attorney and Living Will, which gives you an opportunity to name an agent to make health care decisions for you and to give instructions regarding life-sustaining procedures and other future health care decisions, and
  • West Virginia Organ Donation Form.
• 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.
• This package of forms is provided in MS Word format and can be used by more than one person by filling in the appropriate information.
• Intended to be used only by residents of the State of West Virginia.

Make a living will declaration to ensure that your wishes regarding medical treatment and life support are followed with this easy template form for Wisconsin residents.

•  The Declaration to Healthcare Professionals (also called a "living will") is a document that lets you set out your wishes regarding life-sustaining treatments and procedures, and under what circumstances these treatments or procedures should be provided, withheld or withdrawn should you become comatose or otherwise unable to communicate your wishes.
• This form contains instructions and information to help you complete your Declaration and to make sure it is properly signed and witnessed.
• The Declaration includes a set of Directives to the attending medical personnel that tells them what they must do to comply with the Declaration or, alternatively, what they must do if they feel they cannot comply.
• Available in MS Word format.
• Intended to be used only in the State of Wisconsin.