Alabama Living Will Form (Advance Directive)

The Alabama living will, also known as an “Advance Directive”, is a form that outlines a person’s intentions with regard to their end of life treatment options in addition to selecting a personal proxy to make decisions on your behalf in you cannot do so for yourself.

Laws – Section 22-8A-4

How to Write

Step 1 – Section 1 – Living Will-

  • Enter the Principal’s name
  • The Principal must read carefully through this section

“If I become terminally ill or injured:” –

  • Answer all statements in this section by checking “yes” or “no”

“If I Become Permanently Unconscious: ” –

  • The Principal must carefully read this section
  • Answer the statements by checking “yes” or “no”

“Other Directions” –

  • If the Principal would like to provide additional directions, list them in the lines provided
  • If there are no other directions, simply initial the last line in this section

Step 2 – Section 2 – This section shall address the need for someone to speak on behalf of the Principal and/or assist in making medical decisions –

  • The Principal must enter their initials into the line preceding their choice regarding a health care proxy
  • To select a health care proxy (and an alternate in the event the first becomes unable or unwilling to decide on behalf of the Principal)

Name of Selected Proxy –

  • Relationship to Principal
  • Address
  • City
  • State
  • Zip Code
  • Daytime Telephone
  • Night-time Telephone
  • Enter the same information while selecting an alternate proxy if needed

Instructions for Proxy – The Principal must enter their initials next to their selections

Step 3 – Desired Treatments to be Discussed –

  • List the name(s) of the health care proxy (if any) and any other people with whom the doctor should discuss the positive and negative aspects of the stopping of this treatment

Step 4 – Section 4 – The Principal must enter all of the following information:

  • Printed name
  • The month, day, and year of birth
  • Principal’s signature
  • Date of signature in mm/dd/yyyy format

Step 5 – Witnesses Information – Both witnesses must enter the following:

  • Name
  • Signature
  • Date of signature in mm/dd/yyyy format

Step 6 – Health Care Proxy and Alternate (if any) – Proxy(s) must provide the following:

  • Full name
  • Signature
  • Date of signature in mm/dd/yyyy format