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Georgia Advance Directive for Health Care (Living Will) Form |
The Georgia advance directive for health care(living will) form is a legal document that has been created to allow anyone to specify their personal desires pertaining to their end of life health care. This document must be completed while the Principal is still of sound mind. Most living wills are very individual by design. This particular form covers nearly all aspects of one’s life and how the Principal would like to provide instruction to their agent once they are no longer able to effectively communicate their wishes to their family and medical support team. This document will require that signatures take place before two witnesses but will not require notarization. If at any point, the Principal, while still of sound mind would like to make changes, additions or even revoke the document, they may do so at any time.
Laws – § 31-32-1, et sec
How to Write
Step 1 – Begin by downloading the document and establishing the Principal of the document by Printing their name in the line one and their date of birth in the line provided, in mm/dd/yyyy format.
Step 2 – Review the next four paragraphs providing definitions to the parts of the document, to make it easier to understand as the document is being completed.
Step 3 – Part 1 – Read the information at the beginning of this section before proceeding – then enter the following:
- Select a health care agent to assist in medical decision making when the Principal is unable to do so on their own
- Enter the name of the delegated agent
- Complete address
- Home phone
- Work phone
- Mobile phone
- E-mail Address
- AND
- Enter the information for up to, two alternate agents in the event the initial agent becomes unwilling or unable to continue to serve:
- Enter the name of the first alternate agent (Optional)
- Complete address
- Home phone
- Work phone
- Mobile phone
- E-mail Address
- AND
- Enter the name of the second alternate agent (Optional)
- Complete address
- Home phone
- Work phone
- Mobile phone
- E-mail Address
Powers of the Health Care Agent –
- The Principal must read the following:
- General Powers of the Health Care Agent
- Guidance for the Health Care Agent
- Powers of Health Care Agent After Death
- In sections A, B and C, initial all of the statements that the Principal would like to apply. If the Principal wishes to exclude a selection, simply place an “X” in the lines that should be excluded
- Enter the Principal’s name
- Complete Address
- Telephone Numbers
- Home, Work and Cell Telephone Numbers
- Email address
- Initial the line that best indicates the Principal’s wishes pertaining to the disposition of their body (burial or cremation)
Step 4 – Treatment Preferences – The Principal must read and understand this section before proceeding
- In part two initial each “condition” the Principal would like to make effective
- State the Principal’s treatment preferences by initialing only one of the following, A,B, or C preferences
- OR – there are four separate options below those statements whereas the Principal may select any or all by initialing their choices
- If the Principal would like to provide additional statements or instructions read the information at the top of “Additional Statements” and enter those instructions into the lines provided
- In case of pregnancy the Principal must initial the line should she wish that it apply
Step 5 – Part Three – Guardianship Nomination- In the event the courts shall decide that the Principal should require guardianship over their person:
- The Principal may initial one of the selections provided or; if another person, not listed, would be their preference for nomination enter:
- Nominee’s Name
- Address (Complete)
- All available telephone numbers where the nominee may be reached (Home, Work, Cell)
- Nominee’s E-mail address
Step 6 – Part 4 – Effectiveness and Signatures – The Principal must carefully review the paragraphs in this section prior to proceeding.
- Should the Principal choose to specify a effective date, initial the line and enter a date in mm/dd/yyyy format.
- Enter a date or event
Principal’s Signature – The Principal must read and agree to the competency statement
- Principal must provide their signature
- Date the signature in mm/dd/yyyy format
Witnesses – Only one of the witnesses may be a member of their medical staff or employee of hospice facility etc.
- The witnesses must read the witness statement before applying their signature
- If in agreement, the witnesses must provide the following, respectively:
- Signatures of Witnesses
- Date of Signatures
- Printed names
- Complete addresses
Once the document is completed and witnesses, copies should be provided to any and all who will be a part of this process, as well if the principal has an attorney or family members, copies should be provided to all.
