Health Care Directive (Living Will) printable pdf download

Health Care Directive (Living Will)

HEALTH CARE DIRECTIVE

(LIVING WILL)

WRITTEN BY:

Name:

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Address:

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City:

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Province or

Postal

Territory

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INSTRUCTIONS TO PERSONS COMPLETING THIS DIRECTIVE:



You may wish to discuss this directive with your doctor

before completing it.



Be sure the directive clearly expresses your personal wishes,

ie., if there is any section you do NOT wish to include,

cross it out and initial the cross-out. There are special

instructions in part 5 for expressing personal wishes.



The directive should not be signed until you are in the

presence of your witness.



Your witness is confirming that you are of sound mind and

making this directive of your own free will.

 Keep this original document in a safe but accessible place

known to your family, caregiver, and doctor.

Name of physician _____________________________

Phone number ________________________________

 Give copies of your directive to all whom it may concern.

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Health Care Directive (Living Will)