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New Jersey Advance Health Care Directive(Living Will) Form

The New Jersey advance health care directive(living will) is a legal document that is made available to guide a person, in this case identified as a “Principal” through the process of creating a document that will advise both their medical providers as well as their health care agent as to their personal end of life medical treatment. If the Principal has not yet established a health care agent, they may do so by providing the agent’s information within this document. If the Principal should feel the need, they  may certainly revoke the document at any time.


Laws – 26:2H-53, et seq. Advanced Directives for Health Care

How to Write

Step 1 – Download the document – Designate a Health Care Representative –

  • The Principal must read the paragraph at the top of the page. If in agreement, enter the following information
  • The Principal’s name
  • AND
  • The Health Care Agent’s name
  • Agent’s full home address and telephone number
  • Continue to review the remainder of the section

Step 2 – Alternate Representatives – If for any reason the first Agent is unable to serve, the Principal may provide up to, two (2) additional agent’s to serve consecutively if needed – Enter:

  • Alternates (respective) names
  • Addresses
  • City
  • State
  • Telephone Numbers

Step 3 – Specific Directions –

  • The Principal must read each statement and initial the statement that would best reflect the wishes of the Principal
  • Should the Principal have additional specific instruction enter them on the lines provided, add a sheet and attach, if needed

Step 4 – Signatures and Witnesses –

  • Principal must read and agree to the paragraph in this section then submit:
  • Date the Principal’s signature in dd/m/yy format
  • Signature
  • Address
  • City
  • State
  • AND

Witness Signatures – The witnesses must read and agree to the witness statement and enter:

  • Witnesses (respective) printed names
  • Addresses
  • City
  • State
  • Witness signatures
  • Date of signatures in mm/dd/yyyy format
  • Provide copies to all signatories and other selected interested parties

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