Iowa Living Will Form

The Iowa living will is a legal a document that will provide a declarant an opportunity to provide their own specific instructions with regard to how they wish to have medical staff implement their care in an end of life situation, when there are few viable options and they are in the end stages of their life. Once the document is complete, it must be acknowledged by two (2) witnesses and a notary for the witness of the declarant. In the event the declarant would like to make any changes they may do so at their own discretion. The document may also be revoked at any time.

Laws – Iowa Code Chapter 144A – Life-Sustaining Procedures Act

How to Write

Step 1 – Download this document

Step 2 – It’s vital that the declarant carefully review the first two paragraphs of the document

  • At the end of the first paragraph, the declarant must indicate whether or not they would wish that their physician(s) withhold any life-sustaining procedures by checking “yes” or “no”
  • Once the declarant has carefully reviewed and considered the information provided, they must provide a date in mm/dd/yyyy format, indicating the date in which the information had been reviewed. After which, the declarant must provide the following information:
  • Declarant’s signature (to be provided before a notary public)
  • Typed or Printed name
  • Complete address with Street, City, State and Zip Code
  • Declarant’s date of birth in mm/dd/yyyy format
  • Once the information in this section is complete, a notary shall acknowledge the declarant’s signature

Step 3 – Witness Information – The witnesses must provide their information in the presence of one another as follows:

  • Witnesses (respective) signatures
  • Typed or printed names
  • Addresses
  • City,State, Zip Code

Step 4 – The Declarant as well as the Agent(s) should read the entire “General Information” page as is provided on page two. Copies of the entire completed document must be provided to all signatories and any other interested parties