Missouri Living Will Form| Advance Directive

The Missouri Advance Health Care Directive form, or Living Will gives the patient the power to advise medical staff as to the sort of care they will receive if they become medically incapacitated. This could include the specific methods of medical practice they will receive or the procedures which will follow their death. This document requires attestation by two (2) witnesses and a notary public in accordance with § 404.705§ 459.015.

How to Write

Durable Power Of Attorney For Health Care: Part 1

1 & 2) The principal must enter their details and the details of the agent and alternative agents.

  • Initial the bottom left of each page.
  • Principals name.
  • Address.
  • Principal`s name.
  • County.
  • Agent`s name.
  • Agents address.
  • Agent`s telephone numbers.


Effective Date

4) The principal must designate either 1 or 2 physicians to authorize when the principal is no longer capable of making this decision.


Agent`s Power

5A) The principal can authorize the agent to either allow or withdraw and withhold artificial hydration and nutrition.

  • Initial to authorize withholding and withdrawal of artificial hydration and nutrition.
  • Initial to refuse authorization of withdrawal and withholding of artificial hydration and nutrition.


Effective Date As To Other Authority

The principal can authorize the agent regard other powers over their medical health provision.

  • Initial to authorize what happens to their body after death.
  • Initial to authorize consent for an autopsy or postmortem.
  • Initial to authorize the agent to delegate another agent.
  • Initial to authorize the agent to make an anatomical gift.
  • Check box to authorize specific reasons for anatomical gifts and which anatomical gifts may be donated:- any required tissues or organs, specific tissues or organs. For the purposes of:-transplantation, therapy, research, education, all of the above.
  • Initial to prohibit donation of anatomical gift.


Health Care Directive: Part 2

2) The principal must initial to signify the life prolonging treatments that must be withheld or withdrawn.

  • Artificial nutrition and hydration.
  • Surgery and invasive procedures.
  • Antibiotics.
  • Artificial respiration.
  • Radiotherapy.
  • Heart-lung resuscitation.
  • Dialysis.
  • Chemotherapy.
  • Any other procedures.
  • All life prolonging procedures even when recovery is not expected.



4) The persons involved with this document must enter their details to validate it.

  • Principals name.
  • Date.
  • Principal`s signature.
  • Principals name.
  • Witnesses signature.
  • Witnesses name.
  • Witnesses address.
  • County.
  • Date.
  • Principal` name.
  • Signature of notary.
  • Name of notary.