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

Montana Living Will (Advance Directive)

The Montana living will form has been created in accordance with Statutes §§ 50-9-101 to 50-9-206. The form requires 2 witnesses and is usually notarized as well although this is not essential. The patient will not be able to use this document as their will if they become pregnant. The document allows  individuals to express their end of life and medical health decisions to carers if at any point they are unable to through serious illness These illnesses include a permanent state of unconsciousness, coma and mental impairment.

How to Write

Advanced Directive

The principal must enter their name.

 

Terminal Conditions

1) The principal must check the relevant boxes to specify the kind of treatment they wish to receive.

  • The principal wishes to to offer directions at this time.
  • Withdraw or withhold treatment that prolongs the dying process.
  • Accept treatment to maintain dignity, comfort and relief from pain.
  • Refuse artificial hydration.
  • Refuse artificial nutrition.
  • Allow the use of antibiotics for the prevention of pain but not for the purpose of prolonging life.
  • Check box to show if additional notes are attached to this document.

 

Chronic Illness Or Serious Disability (Optional)

2) Details of wishes regarding any chronic illness the principal may have.

  • Diagnosis.
  • Name of physician.
  • Telephone number of physician.
  • Special directions.

 

Health Care Representative

3A&B) Details regarding the appointing of a health care representative and alternative health care representatives must be entered.

  • Check box to signify whether a health care representative is to be appointed.
  • Name.
  • Address.
  • Telephone numbers.

 

Signatures And Witnesses

The details of the relevant persons concerned with this document must be entered.

  • Date.
  • Principal`s signature.
  • Principal`s name.
  • Principals address.
  • Principal`s telephone number.
  • Witnesses signature,
  • Date.
  • Witnesses name.
  • Witnesses address.
  • State.
  • County.
  • Date.
  • Notary`s name.
  • Notary`s signature.
  • Notary`s residence.
  • Date notary`s commission expires.

 

Special Conditions

The principal must denote any special conditions he would wish to receive.

A) Spiritual preferences

  • Religion.
  • Faith community.
  • Contact person.
  • Would/wouldn`t like spiritual support.

B) Where the principal wishes to die

  • Home.
  • Hospital.
  • Nursing home.
  • Other.

C) Anatomical donation

  • Do not wish to make an anatomical donation.
  • Donate the entire body.
  • Donate specific parts: –
  1. Any organs, tissues or body parts.
  2. Heart.
  3. Kidneys.
  4. Lungs.
  5. Bone marrow.
  6. Eyes.
  7. Skin.
  8. Liver.
  9. Others.

 

D) After death care

The principal must enter details  of the type of care they wish to receive with regards to their body after death.

 

E) Additional directions

The principal must express any other wishes they have with regards to their health care.

  • Details of other directions regarding medical health care.
  • Signature.
  • Date.

F) Distributing this advanced directive

The principal must state where copies of this advanced directive can be found.

  • Check box Yes/No to keep the advanced directive in the Montana End Of Life Registry.
  • Physician`s name.
  • Physician`s address.
  • Physician`s telephone number.
  • Hospital`s name.
  • Hospital`s address.
  • Hospital`s telephone number.
  • Family member`s name.
  • Family member`s address.
  • Family member`s telephone number.
  • Clergy`s name.
  • Clergy`s address.
  • Clergy`s telephone number.