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Date of Directive

LIVING WILL AND DURABLE power OF attorney FOR HEALTH CARE date of Directive : Name of person executing Directive : Address of person executing Directive : A Living Will A Directive to Withhold or to Provide Treatment 1. I willfully and voluntarily make known my desire that my life shall not be prolonged artificially under the circumstances set forth below. This Directive shall be effective only if I am unable to communicate my instructions and: a. I have an incurable or irreversible injury, disease, illness or condition, and a medical doctor who has examined me has certified: 1.

creation of durable power of attorney for health care By this portion of this Directive, I create a durable power of attorney for health care. This power of attorney shall …

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