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Delaware Living Will Form (Advance Directive) |
The Delaware Advance Health Care Directive form, or Living Will adheres to Statutes §§2501 to 2518 and effectively allows a patient to write their wishes regarding the medical treatment they receive if they are now no longer able to through illness for example psychological impairment or a coma. Treatments may include the types of life support they receive, the nutrition they receive and the specific methods of medical practition they will be treated with. Procedures following their impending death are also cover by this document. A Delaware living will form requires two witness.
How to Write
Principal
Enter Name Of Principal At Top Of Page One
Enter Principals Signature at bottom of page 2.
A. End Of Life Instructions
1) Choice to prolong life.
- Initial
2i) Choice not to prolong life in the event of a terminal illness.
- Initial
Initial `I want` or `I don`t want` for specific directions of choosing not to prolong life.
- Artificial nutrition through a conduit.
- Hydration through a conduit.
- Cardiopulmonary resuscitation.
- Mechanical respiration.
- Other (If other enter specific details).
2i) Choice not to prolong life in the event of permanent unconsciousness.
- Initial
Initial `I want` or `I don`t want` for specific directions of choosing not to prolong life.
- Artificial nutrition through a conduit.
- Hydration through a conduit.
- Cardiopulmonary resuscitation.
- Mechanical respiration.
- Other (If other enter specific details).
C. Other Medical Istructions
- Enter details of any other instructions
Principals signature at bottom of page 3.
Power Of Attorney Health Care
A. Designation Of Agent
Enter personal details of agent and alternative agent.
- Full name of agent
- Full name of alternative agent
- Address
- ZIP code
- Home telephone number
- Work telephone number
Principals signature at bottom of page 4.
Part 3. Anatomical Gift Declaration (Optional).
Check box to show what body parts are to be donated
- My body
- Any needed organs or parts
- Selected body parts (Describe body parts to be donated).
Check relevant box(s) to designate purposes of organ/body parts donation.
- Any purpose authorized by law.
- Transplantation.
- Therapy.
- Research.
- Medical education.
Effect Of Copy
Enter personal details to very the effect of a copy of this document.
- Signature
- Name
- Date
- Address
- ZIP code
Principals signature at bottom of page 5.
Statement Of Witnesses
Witnesses must enter their personal details.
- Name of witness
- Address
- ZIP code
- Signature
Enter details of notary (Optional).
- Date
- Expiration of commission
- Name
Principals signature at bottom of page 6.
