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North Dakota Health Care Directive | Medical POA & Living Will

The North Dakota Health Care Directive refers to both living will and power of attorney, joining the two as a ‘Health Care Directive’. It empowers a principal with the choice over any specific medical health care treatment they wish receive if they become unable to express their wishes themselves through illnesses. A North Dakota health care directive also lets the principal select another person called the `Agent` to become the facilitator of the patient`s wishes. The power granted to the agent can be total or it can be restricted by the principal to any degree. The document is a formal declaration and is legally binding in the state of North Dakota, it is in accordance with the US statutes §§ 23- 06.5-01 to -19 and requires 2 witnesses or a notary with the agent having to sign to accept authority.

How to Write

Health Care Directive

The principal must enter their name.

 

Health Care Agent (Part 1)

The health care agent`s and alternative health care agent`s details must be entered.

  • Name.
  • Relationship of agent to principal.
  • Telephone number.
  • Address.

The principal has the option to enter any other specific details regarding the points A – D with relevance to their medical health care.

The principal must initial the relevant blank field to denote that their agent will have power over what will happen to their body after death.

  1. To choose if to donate organs, tissues, and eyes.
  2. To allow the agent to make the choice over what happens to the principal`s body after their death.

The principal has the option to enter any other specific details regarding the agent`s power over their medical health care.

 

Health Care Instructions (Part 2)

A)

The principal must enter details in the respective blank fields to describe their personal feelings with respects to the medical health care they wish to receive.

  • Goals for health care.
  • Fears regarding health care.
  • Religious beliefs regarding health care.
  • Beliefs regarding when life is no longer valuable.
  • Thoughts regarding how a medical condition may affect family members.

B) The principal must enter details in the respective blank fields to describe the type of medical health care they wish to receive.

  • Unable to communicate and with a reasonable chance of recovery.
  • Unable to communicate and dying.
  • Unable to communicate and permanently unconscious.
  • Unable to communicate and completely dependent on others.

The principal must enter details of what they wish regarding receiving pain relief if it is going to affect their alertness.

The principal must enter details of any other wishes they have regarding their medical health care.

  • Who their doctor will be.
  • Where they will receive health care.
  • Where they wish to die and any other wishes regarding dying.
  • What will happen to their body after death.
  • Any other wishes.

 

Making An Anatomical Gift

The principal must describe their wishes regarding an anatomical donation.

  • Check box to donate any anatomical gift.
  • Check box and enter details of any specific anatomical gift.

 

Making The Document Legal (Part 5)

The principal must enter their details.

  • Date.
  • Address.
  • Signature.

 

Notary Public Or Statement Of Witnesses

(Option 1) Notary

The notary`s details must be entered.

  • Date.
  • Signature.
  • Date of expiration of commission.

 

(Option 2) Two Witnesses

The witnesses details must be completed.

  • Date.
  • Name of declarant.
  • Initial the box to acknowledge their status and relationship with the principal.
  • Signature.
  • Address.

 

Acceptance Of Appointment Of Power Of Attorney

The  agent`s and alternative agent`s signatures must be entered.