The following is an example of a policy health (many people still call this Living Will). It is divided into three basic parts. 1) Appointment of Health Care Agent. 2) Health Care Instructions. 3) Making the Legal Document. Like most legal documents can be a little confusing and overwhelming, the presentation create using free medical powerpoint templates. The purpose for the production of these is easily accessible to the public easily. To know how to help people to get something before you expect a lawyer and his proposal for a directive to them. Nobody talks like to think about their death or disability. However, dealing with such issues is a necessary part of life.
This example should not as a substitute for permanent access to legal advice to be licensed by a lawyer. Each person is different. Consult an attorney in your area to discuss your special needs estate planning.
Living Will
I ___________________________________, understand this document, I may take one or both of the following:
PART I: Name another person (called a health agent) to health care decisions for me if I can not decide, or I speak for myself. My health care agent needs to make for me on the basis of the evidence that I presented this paper (Part II), if any, the wishes I have to act made known to him or her, or in my best interest if I did not made my health care wishes known.
And / or
PART II: Give health care instructions to make health care decisions for others, my guideline. When I called the health care agent, these instructions are used by the agent. This guide can also be used by my care, you help others with my health and my family in case I can not make decisions for me.
PART I: HEALTH CARE AGENT appointment
This is who I want health care decisions for me if I can not decide, or I speak for myself (I know I can change my agent or alternate agent at any time and I know I am not an agent or an alternative representative to nominate)
NOTE: When you appoint a representative, should discuss this policy with your health care agent and give your agent a copy. If you do not want to appoint a representative to walk you might leave empty Part I and Part II.
If I decide not able, or am speaking for myself, I trust and appoint ___________________ to health care decisions for me. This person is my health care provider. Relationship of my health to me: ___________________
Phone number of my health care agent: _________________________
Address of my health care agent: _________________________
(OPTIONAL) the appointment of alternate health care agent, if my health is not Agent reasonably possible, and I trust my health care agent appointed _________________ instead. Relationship of my alternate health care to me, some of my alternate health care agent ___________________________Telephone: ___________________________ Address of my alternate health care agent: ___________________________
This is what I want my health care agent to
Do if I decide not to or speak for me (I know I change these decisions)
My agent is the health care system will automatically power down in the section (A) to (D).
My health care agent must follow my instructions in this document or any other instructions I have given to my agent. If I do not care instructions, then my agent must be in my best interest to act. Whenever I am not able to speak or decide for myself, my agent has the health authority:
(A) Make health care decisions for me. This includes the power to give or refuse
Agreement to withdraw all care, treatment, service or process. This includes the decision not to stop or start health care that keeps me and maybe to keep me alive, and deciding on major mental health treatment.
(B) I choose my care.
(C) select where I live and receive care and support, to tell if these decisions, my
health needs.
(D) review my medical records and have the same rights that I would give my
medical records to other people.
If I do not want my health agent to a power, the above in (a) to have (d), or if I want to restrict any power in (A) to (D), I must say here:
______________________________________________________________________
My health agent does not automatically powers down in (a) and (2) below. When I think of an agent of the powers of (1) want (2), is the line I initial spark for the power, then my agent have the power.
______ (A) to decide whether parts of my body, including organs, tissue donation, and eyes, when I die.
______ (2) To decide what happens to my body when I die (burial, cremation).
If I want to say something more about my health care agent powers or limits on the powers to say, I can say here: ________________________________________________________________________
PART II: Health Guide
NOTE: Complete this Part II if you want health care instructions. If you named an agent in Part I, completing this Part II is optional but would be very helpful to your agent. However, if you choose not to appoint an agent in Part I, you have all or part of this Part II if you have a valid advance directive.
This manual is for my health, I can not decide, or I speak for myself.
These instructions must be followed (as long as they address my needs).
These Are My beliefs and values about my health care
(I know I have to change these choices or leave, one of them empty)
I want to help you these things about me you make decisions about my health impacts:
My goals for my health: ________________________________________________________________________________________________________________________________________________
My fears about my health care: ________________________________________________________________________________________________________________________________________________
My spiritual or religious beliefs and traditions: ________________________________________________________________________________________________________________________________________________
My views on life, if not more worth the effort:
________________________________________________________________________________________________________________________________________________
My thoughts about my health affect how my family would:
________________________________________________________________________________________________________________________________________________
This is what I want and not want for my health care
(I know I have to change these choices or leave, one will be empty of them) Many medical treatments used to try to improve my disease or to prolong my life. Examples include artificial breathing by a machine connected to a tube into the lungs, artificial feeding or fluids through tubes, attempts to stop a heart operation to begin dialysis, blood transfusions and antibiotics. Most medical treatments can be tried for a while and then stopped if they do not help. I have these views about my health in such situations: (Note: You discuss general feelings, specific treatments, or leave one of them empty)
If I had a reasonable chance of recovery and were temporarily unable to decide or speak
for myself, I would like to:
________________________________________________________________________________________________________________________________________________
If I may die and were not in a position to decide or speak for myself, I would be to:
________________________________________________________________________________________________________________________________________________
like if I am unconscious and permanently unable to decide in a position, or speak for myself, I would be to:
________________________________________________________________________________________________________________________________________________
If I were completely dependent on others for my diligence and not in a position to decide or speak
me, I would. . . . .
________________________________________________________________________________________________________________________________________________
In any case, my doctors will try to reduce me comfortable and my pain. This is how I feel about the pain, how could it affect my attention or if it is to shorten my life:
________________________________________________________________________________________________________________________________________________
There will other things I want or not want my health, if possible:
Who I would like my doctor:
________________________________________________________________________________________________________________________________________________
Where I would live to get to care:
________________________________________________________________________________________________________________________________________________
What I want to die and other wishes I have about dying:
________________________________________________________________________________________________________________________________________________
My wishes about donating parts of my body when I entered:
________________________________________________________________________________________________________________________________________________
My wishes about what happens to my body when I die (cremation, burial)
________________________________________________________________________________________________________________________________________________
All other things:
________________________________________________________________________________________________________________________________________________
PART III: MAKING THE DOCUMENT LEGAL
This document must be signed by me. It should also be examined, either by a notary
(Option 1), or witnessed by two witnesses (Option 2). It should, if it is validated by or to be observed. I am thinking clearly, I agree with everything that is described in this document and I have this document willingly.
___________________________________
My signature
___________________________________
Date Signed:
___________________________________
Date of Birth:
___________________________________
Address:
If I am not my name, I can ask someone to sign this document for me.
_____________________________________________________
Signature of the person who I asked to sign this document for me.
________________________________________________________
Printed name of the person who I asked to sign this document for me.
Option 1: notary
In my presence on___________________________________ (date) __________________________________________ (name) his / her
Signature on this document or acknowledged that he / she authorized the person signing this document, log in his / her account. I am not listed as an agent or an alternate health care agent in this document.
___________________________________________
(Signature of notary)
(Notary Stamp)
Option 2: Two witnesses
Two witnesses must register. Only one of the two witnesses, a health provider or an employee of a health-care professional direct care to me the day I sign this document.
A witness:
(I) In my presence on _______________________ (date) ________________ (name) his / her signature on this document or acknowledged that he / she authorized the person signing this document, sign in his / her account.
(Ii) I am at least 18 years old.
(Iii) I am not a health care agent or alternate health care agent named in this document.
(Iv) if I have a caregiver or an employee of a caregiver were direct
Care of the person, the above in (A), I in for the first time this box: []
I certify that the information in (i) through (iv) is true and correct.
______________________________________
(Signature of Witness One)
Address: ________________________________________________________________________________________________________________________________________________
Two Witnesses
(I) In my presence on ________________________ (date) _________________ (name) his / her signature on this document or acknowledged that he / she authorized the person signing this document, log in his / her account.
(Ii) I am at least 18 years old.
(Iii) I am not a health care agent or alternate health care agent named in this document.
(Iv) if I have a caregiver or an employee of a caregiver were direct
Care of the person, the above in (A), I in for the first time this box: []
I certify that the information in (i) through (iv) is true and correct.
________________________________________
(Signature of Witness Two)
Address:
________________________________________________________________________________________________________________________________________________
NOTE: Keep this document with your personal documents in a safe place (not in a safe). Give signed copies to your doctors, family members, close friends, health and alternative health care provider agency. Make sure your doctor is ready to follow your wishes. This document must be a part of your medical records to the office of your doctor in the hospital, home care agency, hospice, nursing home or institution where your care.
Some of this information was taken by Minnesota Statutes, Section 145C. 16th This should not be construed as legal advice, it is intended as a public service.