Hawaii Advance Health Care Directive(Living Will) Form

The Hawaii advance health care directive(living will) is a legal document that is specifically designed to allow an individual/Principal, to outline their personal wishes and desires pertaining to the Principal’s end of life health care.  These documents are generally very individual by nature. This form will address nearly all concerns the Principal may have and will guide the Principal appropriately to a clear and concise instructional to be followed by the medical providers as well as the Agent/Health Care Representative. This document will require either the signatures of two witnesses or witness of a notary public, both are not required.

Laws § 327E-2

How to Write

Step 1 – Download the document – Date the document in the top right corner in mm/dd/yyyy format

  • Enter the Principal’s last name
  • First name
  • Middle initial
  • Street Address
  • City
  • State
  • Zip Code

Step 2 – Individual Instructions for Health Care – The Principal must read the statements at the beginning of this section:

  • In each section, initial only one of the choices (A through E)
  • If the Principal has other wishes they would like to place into the document, add a sheet, write the added wishes and/or instructions, sign the Principal’s name, date the sheet and attach it to the document.

Step 3 – Health Care Power of Attorney Agent’s Authority and Obligation – The Principal must read the paragraph at the beginning of this section – In this section, the Principal will delegate their health care agent by entering:

  • Name of Agent
  • Relationship
  • Street Address
  • City State Zip
  • Home Phone
  • Work Phone
  • E-mail

If the agent is unavailable, contact the following person as the alternate agent – enter the information as follows for the alternate:

  • Name of Agent
  • Relationship
  • Street Address
  • City State Zip
  • Home Phone
  • Work Phone
  • E-mail

Initial all of the statements that apply. Enter any decisions that the agent will be excluded from making on behalf of the Principal. When complete, acknowledge this section by submitting:

  • Print the Principal’s full name
  • Enter the Principal’s signature
  • Date of signature (mm/dd/yyyy)

Step 4 – Witnesses Information – Witnesses may not be related, be in any way involved in the Principals health care in patient or outpatient and may have no inheritance rights. Enter the following:

  • Witnesses Printed names
  • Relationship to Principal
  • Street Address
  • City, State, Zip
  • OR
  • Should the Principal decide to use a notary public, they will witness  the signature of the Principal and provide acknowledgement by providing the notary information and shall affix their official seal

Comments

comments