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Other Names: Virginia Living Will Virginia Advance Healthcare Directive Virginia Medical Directive Virginia Advance Medical Directive Virginia Advance Health Care Directive
Virginia Advance Directive document preview

What is a Virginia Advance Directive?

A Virginia Advance Directive is a legal document that outlines your wishes with regard to health care, such as your refusal of or request for a certain medical treatment or procedure, and/or appointment of a chosen decision maker. 
 
The individual making an Advance Directive is called the "principal," while the individuals or entities receiving authority to carry out the principal's wishes are known as "agents." Suitable for residents of Virginia, this free Advance Directive is made for use in Prince William County, Virginia Beach County, Fairfax County, and in all other regions throughout the state. Each Virginia Advance Directive from Rocket Lawyer can be completely personalized to address your specific situation. As a result of this official document, your medical providers will have a record of your decisions, and your agent(s) can offer verification that they have been authorized to act in your interest when you are not able.

When to use a Virginia Advance Directive:

  • You're making sure your loved ones aren't put in the position of making important end-of-life healthcare decisions for you.
  • You're about to draft a complete estate plan, and want to make sure life-sustaining treatments are covered.

Sample Virginia Advance Directive

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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.
even 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 continued to prolong my life as long as possible within the limits of generally accepted health care standards.

__________ (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.

 

Virginia Advance Directive FAQs

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  • How do I write an Advance Directive in Virginia?

    It's simple and easy to record your medical wishes with a free Virginia Advance Directive template from Rocket Lawyer:

    1. Make your Advance Directive - Answer a few questions, and we will do the rest
    2. Send or share - Review it with your healthcare agent(s) or seek legal help
    3. Sign and make it legal - Required or not, witnesses/notarization are a best practice

    This method, in most cases, will be notably more affordable and convenient than finding and working with the average attorney. If necessary, you can start this Advance Directive on behalf of your spouse, an elderly parent, or another family member, and then have that person sign after you've drafted it. Please note that for this document to be accepted as legally valid, the principal must be an adult who is mentally competent when they sign. In the event that the principal is already incapacitated and unable to make their own decisions, a court-appointed conservatorship generally will be necessary. When dealing with such a situation, it would be a good idea for you to connect with a lawyer .

  • Do I need to have an Advance Directive?

    Everyone over 18 years old ought to have an Advance Healthcare Directive (both a Living Will and a Healthcare Power of Attorney) in place. Though it may be painful to think about, there could come a day when you can no longer make medical decisions on your own. Common occasions in which you may consider it useful to make or update your Advance Directive include:

    • You are planning for an upcoming medical procedure or period of hospitalization
    • You are getting older or have declining health
    • You have been given a terminal diagnosis
    • You intend to move into a residential care facility

    Regardless of whether your Virginia Advance Directive has been generated as part of a forward-looking plan or made in response to a recent change in your health, notarization and/or witnesses are strongly recommended for protecting this document and/or your agent if their authority is challenged by a third party.

  • Do I need to hire a lawyer for my Advance Directive in Virginia?

    Making an Advance Directive is generally simple to do; however, you or your agent might have legal questions. Getting a second opinion on the document can take a long time if you try to do it alone. An easier approach might be to request help from the On Call network. Rocket Lawyer Premium members are able to request advice from an attorney with relevant experience or ask additional questions. As always, you can Live Confidently® knowing that Rocket Lawyer is here by your side.

  • What would I typically need to pay to make an Advance Directive in Virginia?

    The cost of finding and working with a lawyer to write an Advance Directive might range between $200 and $1,000. Unlike the other websites that you might come across, Rocket Lawyer offers much more than an Advance Directive template. If you ever require support from a lawyer, your membership provides up to 40% in savings when you hire an attorney.

  • Would I have to take additional actions after I make a Virginia Advance Directive?

    Once you've completed your Advance Directive with the help of Rocket Lawyer, you'll be able to open it anytime, anywhere. As a Rocket Lawyer member, you will be able to make edits, save it in Word or PDF format, or sign it. Each Virginia Advance Directive comes with its own set of helpful tips to follow while finalizing the document. You will need to send a copy of the fully signed document to your agent(s), care providers, and other impacted parties.

  • Does an Advance Directive need to be notarized or witnessed in Virginia?

    The specific requirements governing Advance Directives are different in each state; however, in Virginia, your Advance Directive needs the signatures of two witnesses. As a general rule, witnesses should be at least 18 years old, and no witness should simultaneously be named as your agent.

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