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Forms 21- 40 of 47 Available for 'Living Wills'

North Carolina - Declaration of a Desire for a Natural Death  

___ My physician may withhold or discontinue extraordinary means only. ___ In addition to withholding or discontinuing extraordinary means if such means are necessary, my physician may withhold or discontinue either artificial nutrition or hydration, or both. I also state that I am not the declarant's attending physician or an employee of the declarant's attending physician, or an employee of a health facility in which the declarant is a patient or an employee of a nursing home or...

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Colorado - Declaration as to Medical or Surgical Treatment  

I direct that, in accordance with Colorado law, life-sustaining procedures shall be withdrawn and withheld pursuant to the terms of this declaration, it being understood that life-sustaining procedures shall not include any medical procedure or intervention for nourishment considered necessary by the attending physician to provide comfort or alleviate pain. However, I may specifically direct, in accordance with Colorado law, that artificial nourishment be withdrawn or withheld pursuant to ...

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Washington - Health Care Directive  

I understand by using this form that a terminal condition means an incurable and irreversible condition caused by injury, disease, or illness, that would within reasonable medical judgment cause death within a reasonable period of time in accordance with accepted medical standards, and where the application of life-sustaining treatment would serve only to prolong the process of dying. I further understand in using this form that a permanent unconscious condition means an incurable and ...

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Alabama - Alabama  

Declaration made this ___ day of ___(Month, year). In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal. I understand the full import of this declaration and I am emotionally and mentally competent to make this ...

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Oklahoma - Advance Directive for Health Care  

If my attending physician and another physician determine that I am no longer able to make decisions regarding my medical treatment, I direct my attending physician and other health care providers, pursuant to the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act, to withhold or withdraw treatment from me under the circumstances I have indicated below by my signature. I understand that if I do not sign this paragraph, artificially administered nutrition and hydration will...

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Indiana - Life Prolonging Procedures Declaration  

I, ___, being at least eighteen (18) years of age and of sound mind, willfully and voluntarily make known my desire that if at any time I have an incurable injury, disease, or illness determined to be a terminal condition I request the use of life prolonging procedures that would extend my life. This includes appropriate nutrition and hydration, the administration of medication, and the performance of all other medical procedures necessary to extend my life, to provide comfort care, or...

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Indiana - Living Will Declaration  

If at any time my attending physician certifies in writing that: (1) I have an incurable injury, disease, or illness; (2) my death will occur within a short time; and (3) the use of life prolonging procedures would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn and that I be permitted to die naturally with only the performance or provision of any medical procedure or medication necessary to provide me with comfort care or to ...

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South Carolina - Declaration of a Desire for a Natural Death  

___ I direct that nutrition and hydration BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes. I am aware that this Declaration authorizes a physician to withhold or withdraw life-sustaining procedures. 1. You may give another person authority to revoke this declaration on your behalf.

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Wisconsin - Declaration to Physicians  

If I am unable to give directions regarding the use of life-sustaining procedures or feeding tubes, I intend that my family and physician honor this document as the final expression of my legal right to refuse medical or surgical treatment and to accept the consequences from this refusal. 2. If I have a TERMINAL CONDITION, as determined by 2 physicians who have personally examined me, I do not want my dying to be artificially prolonged and I do not want life-sustaining procedures to be used. ...

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Louisiana - Declaration  

Declaration made this ___ day of ___(month, year). In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal. I understand the full import of this declaration and I am emotionally and mentally competent to make this ...

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Mississippi - Declaration  

DECLARATION made on ___(date) by ___(person's name) of ___(address), ___(Social Security Number). (1). I personally know the Declarant and believe the Declarant to be of sound mind. Am not a physician attending the Declarant or a person employed by a physician attending the Declarant.

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Kansas - Declaration  

Declaration made this ___ day of ___(month, year). In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal. I understand the full import of this declaration and I am emotionally and mentally competent to make this ...

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Nebraska - Declaration  

If I should lapse into a persistent vegetative state or have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician, cause my death within a relatively short time and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician, pursuant to the Rights of the Terminally Ill Act, to withhold or withdraw life sustaining treatment that is not necessary for my ...

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Alaska - Declaration  

The declarant is known to me and voluntarily signed or voluntarily directed another to sign this document in my presence. The foregoing instrument was acknowledged before me this (date) by (name of person who acknowledged). THIS DECLARATION MUST BE EITHER WITNESSED BY TWO PERSONS OR ACKNOWLEDGED BY A PERSON QUALIFIED TO TAKE ACKNOWLEDGEMENTS UNDER Alaska Statutes รต09.63.010.

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Connecticut - Document Concerning Withholding or Withdrawal of Life Support Systems  

DOCUMENT CONCERNING WITHHOLDING OR WITHDRAWAL OF LIFE SUPPORT SYSTEMS. "I, ___(Name), request that, if my condition is deemed terminal or if it is determined that I will be permanently unconscious, I be allowed to die and not be kept alive through life support systems. By terminal condition, I mean that I have an incurable or irreversible medical condition which, without the administration of life support systems, will, in the opinion of my attending physician, result in death within

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Idaho - A Living Will  

[ ] If at any time I should become unable to communicate my instructions, then I direct that all medical treatment, care, and nutrition and hydration necessary to restore my health, sustain my life, and to abolish or alleviate pain or distress be provided to me. [ ] If at any time I should become unable to communicate my instructions and where the application of artificial life-sustaining procedures shall serve only to prolong artificially the moment of death, I direct such procedures be ...

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Utah - Directive to Physicians & Providers of Medical Services  

1. I, ___, being of sound mind, willfully and voluntarily make known my desire that my life not be artificially prolonged by life-sustaining procedures except as I may otherwise provide in this directive. 3. I expressly intend this directive to be a final expression of my legal right to refuse medical or surgical treatment and to accept the consequences from this refusal which shall remain in effect notwithstanding my future inability to give current medical directions to treating ...

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Rhode Island - Declaration  

If I should have an incurable or irreversible condition that will cause my death within a relatively short time, and if I am unable to make decisions regarding my medical treatment, I direct my attending physician to withhold or withdraw procedures that merely prolong the dying process and are not necessary to my comfort, or to alleviate pain. This authorization includes ( ) does not include ( ) the withholding or withdrawal of artificial feeding (check only one box above). The declarant is ...

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Connecticut - Document Concerning the Appointment of Health Care Agent  

I appoint ___(Name) to be my health care agent. If this person is unwilling or unable to serve as my health care agent, I appoint ___(name) to be my alternative health care agent. This document was signed in our presence, by the above-named ___(Name) who appeared to be eighteen years of age or older, of sound mind and able to understand the nature and consequences of health care decisions at the time the document was signed.

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District of Columbia - Declaration  

In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal. I understand the full import of this declaration and I am emotionally and mentally competent to make this declaration. I am not the declarant's attending physician, an employee ...

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