Colorado Advance Health Care Directive (Living Will) Form
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The Colorado advance health care directive (living will) is a document that is designed to assist a Principal to outline their choices with regard to their options for end of life care when they no longer have the ability to communicate on their own. The document will also allow the principal to select specific persons who would assist in overseeing the care that the Principal has specified to ensure that the care is as the Principal has stated clearly within the document. This document must be witness, upon completion, by a notary public. This document may be revoked at any time at the Principal’s discretion.

Laws – § 15-18-101 to § 15-18-113

How to Write

Step 1 – Establish the document by entering the Principal’s name into the Declaration

• The Principal must review the information in this section

Step 2 – Terminal Condition –

• Initial the box that best reflects the Principal’s medical health decisions with regard to the progression of a terminal condition

Step 3 – Artificial Nutrition and Hydration –

• The Principal must enter their initials next to their selected action to be taken as approaching an end of life period

Step 4 – Persistent Vegetative State –

• The Principal must select whether or not they wish to continue life sustaining procedures in this case. The Principal must initial the line that best indicates their choice during this period

Step 5 – Resolution With Medical POA –

• Initial the Principals wishes with regard to the level of involvement with regard to their current medical condition

Step 6 – Consultation with Other Persons –

• The Principal must authorize who they may consult with by entering:
• Name of authorized person
• Relationship to the Principal
• If more space is needed, add more names on a separate sheet and attach it to this document

Step 7 – Notification of Other Persons – Before the healthcare provider may withhold or withdraw any life sustaining procedures, they must make reasonable effort to contact the people listed by the Principal, in advance.

• The Principal must enter the following
• Names of all who should be contacted prior to discontinuance of life sustaining procedures
• Telephone numbers of all contacts
• OR
• Email addresses of contacts

Step 8 – Anatomical Gifts – If the Principal would like to donate organs or tissues or if they choose not to donate any organs or tissues:

• Initial the line preceding the appropriate selection (to the Principal) with regard to organ donation
• If the Principal should choose to donate organs/tissues they must provide a signature. Execute the declaration by dating their signature in dd/m/yy format
• Submit the Principal’s signature

Step 9 – Declaration of Witnesses and Notary Acknowledgement – This document will require the signature and information of two (2) witnesses, before a notary public. The witnesses may not in any way have any interest in the Principal’s estate. The witnesses must carefully read the witness statement prior to the application of signature. Submit the following witness (respective) information as follows:

• Signatures of Witnesses
• Printed names
• Complete addresses of witnesses

Notarization (Optional, but if used, the notary must witness all signatures) – Once the Notary Public has witnessed as well as recorded the signatures of the Principal and both witnesses, the notary shall acknowledge the document by the completion of the information in the notary section of this document. The notary will apply their seal in acknowledgment.