Advance Health Directive

An Advance Health Care Directive, also known as an Advance Directive, is a legal document that specifies how you want to be cared for at the end of your life.

To complete an Advance Directive, you must specify the types of treatments you would and would not like to receive at the end of your life. It includes your Living Will and Health Care Proxies (or Health Care Power of Attorney).

This worksheet can help you prepare for the decisions you'll need to make on those forms, as well as any discussions you may have with your doctors or family.

Determine the types of life-sustaining care you desire and do not want at the end of your life.

This will be your Living Will. Life-Supporting Treatments can include medical equipment to assist with breathing, medical devices to deliver food and water, blood transfusions, dialysis, antibiotics, and surgery.

I would like all life support treatments that might prolong my life
I would like no life support treatments, even if they might prolong my life
I would like some life support treatments, including: Medical devices to aid breathing (ventilator); Medical devices to aid nutrition and hydration (tube feeding); Blood transfusions; Dialysis; Antibiotics; Surgery

Decide who you want to make medical decisions on your behalf should you no longer be able to make your own health care decisions.

This person will be your Health Care Proxy, also known as a Health Care Power of Attorney

If I should become unable to make my own health care decisions, the person I would like to make my health care decisions for me, according to my wishes, is ______________________________.
If this person is unable to serve, I would like my successor health care power of attorney to be ______________________________.

Decide if you want a Do Not Resuscitate (DNR) order.

A DNR order is separate from a Living Will, even if your Living Will states that you do not want life-support treatments at the end of your life. If you'd like to have a DNR order, you'll need to meet with your doctor to complete the forms.

In case my heart or breathing should stop, I want every effort made to revive me
In case my heart or breathing should stop, I want no effort made to revive me
I have met with my doctor and filled out my DNR form
I have made copies of my DNR forms and distributed them to:
My primary care physician
My Health Care Proxy
Any caregivers, nurses, or other doctors who are managing my care

Decide if youd like to become a registered organ donor

I would not like to donate my organs
If I should die, I would like to donate my organs
I have registered as an organ donor with my state’s donor registry

Complete your states paperwork to make these decisions legal.

Use the decisions you've made here to help you complete your state's advance directive forms. Depending on the state you live in, the form for a Living Will and the form for a Health Care Proxy may be combined into a single form, or they may be separate forms.

Download your states forms from our list of State-by-State Advance Directive Forms
Have two witnesses over the age of 18 sign the form and get the form notarized, if necessary
If you would like a DNR order, contact your doctor and complete the form together

Store these forms in an obvious, accessible location where they can easily be found in the event of an emergency, and make copies of these forms for your health care agent.

Be sure to tell your health care power of attorney and your family where youve stored these documents.

Should you have any further inquiries, please feel free to submit them below.

In order to create an Advance Directive, you're going to need to fill out your state’s particular forms.

State-by-State Advance Directive Forms

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