Delaware Advance Health Care Directive(Living Will) Form

The Delaware advance health care directive(living will) is a legal document that will allow a Principal to outline all aspects of their wishes for their end of life treatment. This will include the opportunities to set up a power of attorney/agent to oversee the specific instructions on the Principal’s document. As well, the Principal will have the ability to state whether or not they would like to participate in organ and/or tissue donation. The document will require the signature and information from two(2) witnesses. Notarization is optional. This document may be revoked at any time the Principal would feel it necessary

Laws – 16 §2501, et seq. Health Care Decisions

How to Write

Step 1  Download the document – Establish the author on the first page

Step 2 – Instructions for Health Care Decisions – The Principal must carefully review the information in this section

  • Enter the Principal’s name at the bottom of every page of this document

Step 3 – End of Life Instructions –

  • The Principal must check or initial their selection to prolong or not to prolong their life
  • Provide specific instructions in the even that no form of life sustaining treatment will matter in saving their life. Select and initial from the selections provided and initial each with the Principal’s choice with regard to it’s use

In the event of permanent unconsciousness:

  • Initial the lines from the selection and then select how you would like it to be used

Relief from Pain – Read the information in this section

  • If the Principal has other medical instructions, enter the information into the lines provided, adding a sheet if needed (if there is an additional sheet, attach a copy to the document

Step 4 – Power of Attorney for Health Care – In this section, the Principal may designate and Agent to oversee the instructions prepared by the Principal by providing the following information:

  • After reading the two paragraphs as the beginning of the section, enter the name of the designated agent
  • Enter the name of an alternate agent in the event the first agents becomes unwilling or unable to serve
  • Enter the name of the initial agent
  • Address
  • City
  • State
  • Zip Code
  • Home Phone Number
  • Work Phone Number
  • AND
  • Enter the name of the alternate agent
  • Address
  • City
  • State
  • Zip Code
  • Home Phone Number
  • Work Phone Number
  • AND
  • The Agents must carefully review and agree to the following three (3) titles:
  • Agents Authority
  • When Agent’s Authority Becomes Effective
  • Agent’s Obligation

Step 5 – Anatomical Gift Declaration – This section is optional –

  • If the Principal wishes to make anatomical donations check any of the options that would apply to their wishes
  • After the selections have been checked enter the date that the selections were applied in mm/dd/yyyy format
  • Submit Principal’s signature
  • Printed name
  • Address
  • City
  • State
  • Zip Code

Step 6 – Witness Signatures and Information – There must be two witnesses that sign in the presence of one another.

  • Witnesses must both read and agree to the witness statement
  • Once read and should the witnesses agree:
  • Enter the names of each witness
  • Addresses
  • City, State, Zip Codes of each witness
  • Witness Signatures
  • Date of signatures in mm/dd/yyyy format
  • If so desired, the Principal may have the witnesses signatures witnessed by a notary public. If so, the notary shall acknowledge the signatures by completion of the notary public section. The notary shall also affix their official seal (if any)
Delaware Advance Health Care Directive(Living Will) Form

Delaware Advance Health Care Directive(Living Will) Form

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