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LIVING WILL
and
HEALTH CARE POWER OF ATTORNEY
DECLARATION
and
HEALTH CARE POWER OF ATTORNEY
(LIVING WILL)
(HEALTH CARE PROXY)
(LIVING WILL AND HEALTH CARE PROXY)
DECLARATION
and
HEALTH CARE PROXY
LIVING WILL
and
MEDICAL DURABLE POWER OF ATTORNEY
DOCUMENT CONCERNING WITHHOLDING OR WITHDRAWAL OF LIFE-SUPPORT SYSTEMS
HEALTH CARE INSTRUCTIONS
DOCUMENT CONCERNING THE APPOINTMENT OF A HEALTH CARE REPRESENTATIVE FOR HEALTH CARE DECISIONS
OF
DECLARATION
and
HEALTH CARE POWER OF ATTORNEY
LIVING WILL
and
DESIGNATION OF HEALTH CARE SURROGATE
DECLARATION
and
STATUTORY FORM
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
A LIVING WILL
A Directive to Withhold or to Provide Treatment
and
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
LIVING WILL DECLARATION
and
COMBINED DURABLE POWER OF ATTORNEY FOR HEALTH CARE AND HEALTH CARE REPRESENTATIVE APPOINTMENT
DECLARATION
and
DESIGNATION OF ADVOCATE FOR HEALTH CARE DECISIONS
HEALTH CARE POWER OF ATTORNEY
DECLARATION OF A DESIRE FOR A NATURAL DEATH
and
HEALTH CARE POWER OF ATTORNEY
HEALTH CARE DIRECTIVE
and
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
ADVANCE HEALTH-CARE DIRECTIVE
INSTRUCTIONS FOR HEALTH CARE
and
HEALTH CARE POWER OF ATTORNEY
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
DECLARATION
HEALTH CARE PROXY OF
ADVANCE DIRECTIVE OF
LIVING WILL DECLARATION
and
HEALTH CARE POWER OF ATTORNEY
ADVANCE CARE PLAN
HEALTH CARE POWER OF ATTORNEY
LIVING WILL
ADVANCE DIRECTIVE
and
MEDICAL POWER OF ATTORNEY
HEALTH CARE DIRECTIVE
and
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
DECLARATION TO PHYSICIANS
(WISCONSIN LIVING WILL)
and
HEALTH CARE POWER OF ATTORNEY
LIVING WILL
AND
MEDICAL POWER OF ATTORNEY
I. LIVING WILLI. ADVANCE DIRECTIVEI. DECLARATIONI. DOCUMENT CONCERNING WITHHOLDING OR WITHDRAWAL OF LIFE SUPPORT SYSTEMSI. A LIVING WILL - A DIRECTIVE TO WITHHOLD OR TO PROVIDE TREATMENTI. LIVING WILL DECLARATIONI. HEALTH CARE INSTRUCTIONSI. DECLARATION OF A DESIRE FOR A NATURAL DEATHI. HEALTH CARE DIRECTIVEI. DECLARATION TO PHYSICIANS (WISCONSIN LIVING WILL)Declaration made this ______ day of ____________________, _____. I, , willfully and voluntarily make known my desire that my dying not be artificially prolonged under the circumstances set forth below, and I do hereby declare:This is an important legal document known as an advance directive. It is designed to help you communicate your wishes about medical treatment at some time in the future when you are unable to make your wishes known because of illness or injury. These wishes are usually based on personal values. In particular, you may want to consider what burdens or hardships of treatment you would be willing to accept for a particular amount of benefit obtained if you were seriously ill. You are encouraged to discuss your values and wishes with your family or chosen spokesperson, as well as your physician. Your physician, other health care providers, or medical institution may provide you with various resources to assist you in completing your advance directive. Brief definitions are listed below and may aid you in your discussions and advance planning. Initial the treatment choices that best reflect your personal preferences. Provide a copy of your directive to your physician, usual hospital, and family or spokesperson. Consider a periodic review of this document. By periodic review, you can best assure that the directive reflects your preferences. I, , being of sound mind, willfully and voluntarily make this Declaration for my care to be followed if I become unable to express my desires directly as a consequence of physical or mental incapacity or disability, regardless of whether this is caused by illness, accident, or other injury. This document is intended to direct all persons who are involved with my care including my relatives, physicians or personal representatives which I have appointed, or which hereafter may be appointed by the courts.
__________ (initial) I have a terminal condition
__________ (initial) or I have an irreversible condition
__________ (initial) or I am in a persistent vegetative state
AND if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain.
TO RECEIVE artificially administered nutrition and hydration (food and fluids).NOT TO RECEIVE artificially administered nutrition and hydration (food and fluids) procedures, except as deemed necessary to provide me with comfort care.However, if at any point it is determined that it is not possible that the fetus could develop to the point of live birth with continued application of life-prolonging procedures, it is my preference that this document be given effect at that point. If life-prolonging procedures will be physically harmful or unreasonably painful to me in a manner that cannot be alleviated by medication, I request that my desire for personal physical comfort be given consideration in determining whether this document shall be effective if I am pregnant. I have discussed these decisions with my physician and have also completed a Physician Orders for Scope of Treatment (POST) from that contains directions that may be more specific than, but are compatible with, this Directive. I hereby approve of those orders and incorporate them herein as if fully set forth. I have not completed a Physician Orders for Scope of Treatment (POST) form. If a POST form is later signed by my physician, then this living will shall be deemed modified to be compatible with the terms of the POST form.
I designate , who may be reached at , as my Primary Physician.
including but NOT including . unless I initial the following line:
(YOU MUST DATE AND SIGN THIS LIVING WILL AND DESIGNATION
(YOU MUST DATE AND SIGN THIS DESIGNATION
IN THE PRESENCE OF TWO WITNESSES)
I affirm that this Living Will and Designation is not being made as a condition of treatment or admission to a health care facility. I have read and understand the contents of this document and the effect of this grant of powers to my . I am emotionally and mentally competent to make this declaration.
I affirm that this Designation is not being made as a condition of treatment or admission to a health care facility. I have read and understand the contents of this document and the effect of this grant of powers to my . I am emotionally and mentally competent to make this declaration.
I designate , who may be reached at , as my Primary Physician.
We, the undersigned witnesses, state that in the presence of each other and we have witnessed the signing of this living will by . Further, at least one of us is not a spouse or blood relative of .
We, the undersigned witnesses, state that in the presence of each other and we have witnessed the signing of this Living Will and Designation by . I have not been appointed as 's or Alternate . At least one witness is not 's spouse nor blood relative.
I have not been appointed as 's or Alternate . At least one witness is not 's spouse nor blood relative.
Date: ______________________________
Date: ______________________________
The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by , who is personally known to me or who has produced ________________________________ as identification.
Before me, a Notary Public (or justice of the peace) in and for said county, personally appeared the above named , ________________________________, and ________________________________, who acknowledged that they did sign the foregoing instrument, and that the same is their free act and deed. In testimony whereof, I have hereunto subscribed my name at ________________________________, this _____ day of ____________________, ______.
This instrument was acknowledged before me on this _____ day of ____________________, ______ by .
On this _____ day of ____________________, ______, before me personally appeared , to me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed same as his/her free act and deed.
On this _____ day of ____________________, ______, before me, ________________________________, personally appeared , known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same as for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
_________________________________
My commission expires _____________
You should sign this document in the presence of a notary public. You should sign this document in the presence of two witnesses who then sign the document in your presence and in each other's presence. You should sign this document in the presence of a notary public and two witnesses who then sign the document in your presence and in each other's presence.(your Agent)
You should discuss the document and your wishes with any person you want to designate as an Agent before doing so to assure they agree to act on your behalf.
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It's fast and simple to document your medical preferences with a free New Jersey Advance Directive template from Rocket Lawyer:
This method is often notably less expensive than working with the average provider. If necessary, you can fill out this Advance Directive on behalf of your spouse, an elderly parent, or another relative, and then have that person sign when ready. Please note that for this document to be considered valid, the principal must be a mentally competent adult when they sign. In the event that the principal has already been declared legally incompetent, a conservatorship generally will be required. In such a situation, it would be best to speak to a lawyer .
If you are over 18 years old, you should have an Advance Healthcare Directive (both a Living Will and a Healthcare Power of Attorney). Even though it can be difficult to acknowledge, there might come a day when you are not able to make important decisions on your own. Here are some typical circumstances in which you might consider it useful to make or update your Advance Directive:
Whether this New Jersey Advance Directive is being produced as a result of a change in your health or as part of a forward-looking plan, notarization and/or witnesses are strongly encouraged as a best practice for protecting this document and your agent if someone questions their authority.
Making an Advance Directive is typically straightforward, but you or your agent may still have legal questions. Finding a legal professional to proofread your New Jersey Advance Directive could be time-consuming and relatively expensive. An easier and more cost-effective route is to go through the Rocket Lawyer attorney network. With a Premium membership, you can have your document evaluated by an Rocket Lawyer network attorney with relevant experience. As always, you can rest assured that Rocket Lawyer is here to support you.
The fees associated with hiring an attorney to make an Advance Directive could add up to anywhere from two hundred to one thousand dollars. When using Rocket Lawyer, you are not just filling out an Advance Directive template. If you ever need support from a lawyer, your Rocket Lawyer membership offers up to a 40% discount when you hire an attorney from our Rocket Lawyer attorney network.
Attached alongside each Advance Directive, there's a set of helpful tips to follow while finalizing the document. With a membership, you can make edits, download, or sign it. Finally, your agent(s) and care providers should receive copies of your final document.
The specific requirements and restrictions for Advance Directives vary by state; however, in New Jersey, your document must be signed by a notary public or two witnesses. As a basic standard, witnesses will need to be at least 18 years old, and none should simultaneously be named as your agent.
