Living Will and Advance Healthcare Directive
I, __________, being of sound mind, make this declaration to state my wishes if I become unable to make my own medical decisions.
1. Life-Sustaining Treatment
If I have a terminal condition or am permanently unconscious: __________.
2. Nutrition and Hydration
__________
3. Pain Relief
__________
4. Organ Donation
__________
Witness Attestation
We, the undersigned witnesses, each being at least eighteen (18) years of age, declare that __________ signed this document in our presence, appeared to be of sound mind and under no duress, and that we signed as witnesses in the presence of __________ and of each other. Neither of us is a beneficiary under this document.
Witness 1 Name and Address: ____________________________________________
Witness 2 Name and Address: ____________________________________________
Declarant: __________
Date: ____________
Witness 1: __________
Date: ____________
Witness 2: __________
Date: ____________
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