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Thinking about and planning ahead for emergencies and end-of-life situations when you are in good health gives you and your loved ones the opportunity to prepare for a medical crisis that can happen to anyone at any time.

Instructions and Explanations

Download a copy of the Instructions for the Advance Directive for Healthcare (pdf)

Part One

Part One of this form lets you name a person as your “agent” to make health care decisions for you if you become unable to make your own decisions, or earlier if you indicate when you want the Agent's authority to start, including when your Advance Directive is signed. You should choose as your agent (and alternates) people you trust, who are going to be comfortable making what might be hard decisions on your behalf. They should know you and be guided by your values in making choices for you.

You should notify your agent and alternates that you have named them, and they need to agree to act as your agent if asked to do so. Your agent does not have authority to make decisions for you until you are unable to make your own decisions, unless you specify an earlier time or condition that gives your Agent authority to make health care decisions for you.

If you do not appoint an agent, and then become unable to make your own decisions, someone may be found to make health care decisions for you.

Part Two

Part Two of this form lets you state Treatment Wishes. Choices are provided for you to express your wishes about having, not having or stopping treatment necessary to keep you alive under certain circumstances. Space is also provided for you to write out any additional or specific wishes based on your values, health condition or beliefs.

Part Three

Part Three of this form lets you express your wishes about organ or tissue donation.

Part Four

Part Four is for you to express your wishes about disposition of your remains.

Part Five

Part Five of this form is for signatures. You must sign and date the form in the presence of two witnesses. The following persons may not serve as witnesses: your agent and alternate agents, your spouse or partner or your heirs.

Download your own Advance Directive for Healthcare (pdf)