ADVANCE HEALTH CARE DIRECTIVE

This attorney-style template allows you to clearly document your medical, mental health, and end-of-life care preferences. It ensures your healthcare wishes are known, legally recognized, and can be honored if you become unable to communicate them yourself.

It includes:

• Health Care Agent designation with primary and alternate agents
• Choices for life-sustaining treatment, nutrition, hydration, and comfort care
• Mental health treatment preferences, including medications, hospitalization, and treatment modalities
• Organ and tissue donation options
• Values and personal statement section to guide healthcare providers
• Emergency contact and primary physician information
• Witness and notary acknowledgment sections for legal validity

Format: Fillable PDF (print or complete digitally)

Use Cases: Health care planning, end-of-life directives, estate planning

Notarization: Notary certificate included (optional, but recommended in many states)

⚠️ Disclaimer:

This is a general-use form. Laws vary by state. Consult an attorney to ensure compliance with your state’s requirements. Utsey Notary Services LLC does not provide legal advice.

Instructions:

Download instantly after purchase. Complete the form digitally or print. Have it notarized by Utsey Notary Services or any licensed notary before sharing it with your healthcare agent, family, or physician.