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

Alabama Living Will Form (Advance Directive)

The Alabama advance directive, also known as a ‘health care proxy’, is a form that allows a person to make their end of life medical decisions through a written statement. The decisions are related to if they should be incapacitated and not able to consciously make a determination of the medical path the hospital or caretaker should conduct. Also, if the patient becomes in a vegetative state with no recourse, they make pre-determined statements that will end their life if the situation is to arise such as switching off feeding and/or breathing devices.

How to Write

Step 1 – Download the form and complete by filling-in the following blank fields located in Section 1;

  • Name of principal;
  • Initial if the principal:
    • would like to have life sustaining treatment if terminally ill or injured
    • would like to have food or water sent through a tube if terminally ill or injured
    • would like food or water if permanently unconscious
  • If there are any other things they would like done they are to write and describe in the four (4) blank fields. If not, initial next to the line that says “No, I do not have any other directions”.

Step 2 – In Section 2, enter the details of the person the person would like to speak for them by writing the following:

  • Initial if the principal does or does not want a proxy

If the principal would like a proxy, the following should be written:

  • First choice for proxy which should include their relationship, address, city, and phone number
  • If there is a second choice as well, enter their information

In the next few lines there will be directions for the proxy such as;

  • Making decisions about food and water through an IV
  • Making decisions strictly based on the directions listed on the document
  • Make decisions on the form and not covered by the document
  • Have the proxy be able to make decisions even if it is said otherwise on the form

Step 3 – in Section 3 the principal should acknowledge the following:

  • In the first blank area enter the people who should listen to the doctor about the positives and negatives of no longer receiving life sustaining food and water.

Step 4 – In section 4 the following signatures are needed:

  • Principal
  • Two (2) Witnesses
  • Proxy