Living Will Forms > Free Hawaii Living Will Forms | Advance Health Care Directive > Hawaii Living Will Form (Advance Directive)

Hawaii Living Will Form (Advance Directive)

The Hawaii living will form is a document drawn up in accordance with US Statutes §§327E-1 to 327E-16 . A Hawaii living will requires two witnesses or a notary. The document allows a patient, who is often called the `Principal`, to choose the medical treatment they will receive and make these decisions legally binding should they become ill in such a way so as they are no longer able to make these choices. The document is not legally binding should the principal become pregnant.

How to Write

A) Statement Of Declaration

The principal must enter their personal details.

  • Date.
  • Name.

 

Feeding Artificialy

State whether or not artificial feeding will be required.

  • Check box to not have artificial delivery of food.
  • Check box to have artificial delivery of food.
  • Principal`s signature.
  • Principal`s address.

Statement Of Witnesses

Enter witnesses details.

  • Name.
  • Address.

 

Notarization

Enter details for notarization.

  • Principal`s name.
  • Witnesses names.
  • Date.
  • Notary`s signature.
  • Office/Position of notary.

 

Durable Power Of Attorney

Part 1: Designation of Agent

1) Enter agent`s and alternative agent`s details.

  • Name.
  • Address
  • ZIP code.
  • Home telephone number.
  • Work telephone number.

 

Agent`s Authority

2) Principal must enter specific details regarding exceptions of health care provision for prolonging of life.

 

Agent`s effectiveness Of Authority

3) Check the box to state immediate effect of agent`s authority.

 

Part 2: Donation Of Organs (Optional)

6) Designate specific details for tissue/organ and body part donation and specific uses of these.

  • (a) Check box to donate any required tissues, organs and body parts.
  • (b) Check box to donate only specific tissues, organs and body parts stated by the principal.
  • (c) Check box to denote the gift of tissues, organs and body parts for specific purposes denoted by `Striking Through` any unwanted uses.

 

Part 3: Primary Physician (Optional)

7) Enter details of primary physician and alternative primary physician.

  • Name.
  • Address.
  • ZIP code.
  • Telephone number.

 

Signatures

9) Enter principal`s details.

  • Printed name.
  • Signature.
  • Date.
  • Address.

 

Witnesses

Alternative Number 1

10) Enter details of witnesses.

  • Printed name.
  • Signature.
  • Date.
  • Address.

Alternative Number 2

Enter details of notary.

  • County.
  • Date.
  • Name of notary.
  • Name of principal.
  • Signature of notary.