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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.
make health care decisions for you, except to the extent that there are limits provided by law.) In exercising the authority under this durable power of attorney for health care, my agent shall act consistently with my desires as stated below and is subject to the special
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