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New Mexico Advance Health Care Directive(Living Will) Form |
The New Mexico advance health care directive(living will) form is a legal document that is made available to a person (principal) who would like (while of sound mind) to prepare in advance for the quality of medical care they would wish receive, when/if reaching end of life circumstances. The form will provide a form of reference to their physicians and health care agent, when/if the principal shall reach the end of life circumstances that leave them unable to verbally communicate their wishes any longer.
The Principal may use the document to appoint a health care agent to speak on their behalf if they haven’t already done so. The agent they choose will be obligated to ensure that the principal’s wishes are honored. As long as the principal is of sound mind, however, the document may be changed or revoked as they choose.
How to Write
Step 1 – Once the Principal has downloaded the document, they must begin by reading the “Explanation.”
Step 2 – Power of Attorney for Healthcare -Read the information at the top of this section then enter:
- The full name of the agent
- Street address
- City, State, Zip Code
- Home Phone
- Work Phone
If the primary agent, for any reason, is no longer able to serve in the required capacity on behalf of the principal, then the principal may appoint, in advance, up to two additional alternate agents to take over the position by entering the following:
- The full name of the agents (respectively)
- Street addresses
- City, State, Zip Codes
- Home Phones
- Work Phones
Agent’s Authority – The principal must review the information in this section –
- If there are limitations, restrictions or exceptions, enter them into the box provided
- Read “Agent’s Authority: and “Nomination of a Guardian”
Step 3 – Instructions for Healthcare – Read the statement and the top of this section and proceed:
- Read the statements at the beginning of the following sections and initialing the statements below each, that best reflect the wishes of the principal
- End of Life Decisions
- Artificial Nutrition and Hydration
- Relief From Pain
- Anatomical Gift Designation
- Other Wishes – If the principal has other wishes to express, enter them into this section
Step 4 – Designation of Primary Physicians – Provide the following information:
- Names of Primary and Alternate Physicians
- Street addresses
- City, State and Zip Codes
- Telephone numbers
- Read – “Other Provisions,” “Effect of Copy,” and “Revocation”
Step 5 – Signatures of Principal and Witnesses –
- Enter the Principal’s signature
- Date the signature in mm/dd/yyyy format
- Printed name
- Social Security Number (optional)
- Street address
- City, State, Zip Code
Witnesses – Enter:
- Witnesses signatures
- Date of signatures
- Printed names of witnesses
- Address
- City, State and Zip Codes
- Provide copies to all signatories, physicians, facilities and any other parties the principal would deem necessary
