$13.95

Add to cart

Alabama _______________________________________________________ Date: ______________________________ -4- nature of Second Choice for Proxy: I, ________________________________________________________, am willing to serve as the health care proxy if the first choice cannot serve. Signature: _____________________________________________, am willing to serve as the health care proxy. Signature: _____________________________________________________________________ Date: ______________________________ Sig________________ Signature: _____________________________________________________________________ Date: ______________________________ -3- Section 5. Signature of Proxy I, _________________________________________ Signature: _____________________________________________________________________ Dated: ______________________________ Name of second witness: _________________________________________any part of his or her estate. I am at least 19 years of age and am not directly responsible for paying for his or her medical care. Name of first witness: ____________________________________________ believe this person to be of sound mind. I did not sign the person's signature, and I am not the health care proxy. I am not related to the person by blood, adoption, or marriage and not entitled to _________________________________ Date signed: ___________________________________________________________________ Section 4. Witnesses (two witnesses need to sign) I am witnessing this form because I_________________________________________________________________ The month, day, and year of your birth: _____________________________________________ Your signature: ________________________________ my wishes, with my health care proxy, if I have one, and with the following people: _____________________________________________________________________________ Section 3. My signature Your name: __by. If the time comes for me to stop receiving life sustaining treatment or food and water through a tube or an IV, I direct that my doctor talk about the good and bad points of doing this, along withe that I get to a doctor or hospital who will follow my directions. If I am pregnant, or if I become pregnant, the choices I have made on this form will not be followed until after the birth of the baher directions. Section 2. The things listed on this form are what I want. -2- I understand the following: If my doctor or hospital does not want to follow the directions I have listed, they must se_________________________ _____________________________________________________________________________ If you do not have other directions, place your initials here: ________ No, I do not have any otthe directions I have listed on this form, I also want the following: _____________________________________________________________________________ ____________________________________________________to have food and water provided through a tube or an IV if I am permanently unconscious. _______ Yes ______ No OTHER DIRECTIONS: Please list any other things you want done or not done. In addition to y need to be given food and water through a tube or an IV to keep me alive if I can no longer chew or swallow on my own or with someone helping me. Place your initials by either "yes" or "no": I want tment if I am permanently unconscious. _____ Yes ____ No Artificially provided food and hydration (Food and water through a tube or an IV) - I understand that if I become permanently unconscious, I mato have life sustaining treatment, I will still get medicines and treatments that ease my pain and keep me comfortable. Place your initials by either "yes" or "no": I want to have life-sustaining treadiagnosis. Life sustaining treatment - Life sustaining treatment includes drugs, machines, or other medical procedures that would keep me alive but would not cure me. I know that even if I choose not s condition will last indefinitely without hope for improvement and have watched me long enough to make that decision. I understand that at least one of these doctors must be qualified to make such a sness is when my doctor and another doctor agree that within a reasonable degree of medical certainty I can no longer think, feel anything, knowingly move, or be aware of being alive. They believe thi "yes" or "no": I want to have food and water provided through a tube or an IV if I am terminally ill or injured. _______ Yes _______ No -1- IF I BECOME PERMANENTLY UNCONSCIOUS: Permanent unconscioully ill or injured I may need to be given food and water through a tube or an IV to keep me alive if I can no longer chew or swallow on my own or with someone helping me. Place your initials by either life sustaining treatment if I am terminally ill or injured. ______ Yes ______ No Artificially provided food and hydration (Food and water through a tube or an IV) - I understand that if I am terminaeven if I choose not to have life sustaining treatment, I will still get medicines and treatments that ease my pain and keep me comfortable. Place your initials by either "yes" or "no": I want to have the near future from this condition. Life sustaining treatment - Life sustaining treatment includes drugs, machines, or medical procedures that would keep me alive but would not cure me. I know that peak for myself. IF I BECOME TERMINALLY ILL OR INJURED: Terminally ill or injured is when my doctor and another doctor decide that I have a condition that cannot be cured and that I will likely die inons by tearing them up and by telling someone at least 19 years of age of my wishes and asking him or her to write them down. I understand that these directions will only be used if I am not able to sothers follow the directions I am writing down. I know that at any time I can change my mind about these directions by tearing up this form and writing a new one. I can also do away with these directi___________________________________, being of sound mind and at least 19 years old, would like to make the following wishes known. I direct that my family, my doctors and health care workers, and all nce directive. If you do have an advance directive, be sure that your doctor, family, and friends know you have one and know where it is located. Section 1. Living Will I, ____________________________the State of Alabama to make your wishes known about what medical treatment or other care you would or would not want if you become too sick to speak for yourself. You are not required to have an advauld be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com -3- Living Will This form may be used in to make sure it fits your particular situation. You should also consult an attorney whenever a document is negotiated with another party. Any possible tax consequences arising out of this document shotate. These forms should only be a starting point for you and should not be used without consulting with an attorney first. Before using or signing this document you should have an attorney review it any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to sarant's living will or proxy designation indicates otherwise. -2- [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability forgarding the providing, withholding, or withdrawal of life-sustaining treatment or artificially provided nutrition or hydration, shall take precedence over a living will of a Declarant, unless the Declt of the Declarant's medical records. (g) In the event a Declarant has executed both a living will and a proxy designation, the decisions by the health care proxy duly designated under this chapter red other health care providers rendering treatment to the Declarant. The health care provider shall make the advance directive for health care, or a copy of the advance directive for health care, a parfect during the course of the Declarant's pregnancy. (f) It shall be the responsibility of the Declarant to provide a copy of the advance directive for health care to his or her attending physician anrminal illness or injury or is in a state of permanent unconsciousness. (e) The advance directive for health care of a Declarant who is known by the attending physician to be pregnant shall have no efe of whom shall be qualified and experienced in making such diagnosis, have personally examined the Declarant and have diagnosed and documented in the medical record that the Declarant has either a teysician determines that the Declarant is no longer able to understand, appreciate, and direct his or her medical treatment; and (2) two physicians, one of whom shall be the attending physician, and ony will of the Declarant or codicil thereto, or directly financially responsible for Declarant's medical care. (d) An advance directive for health care shall become effective when: (1) The attending ph proxy therein, related to the Declarant by blood, adoption, or marriage, entitled to any portion of the estate of the Declarant according to the laws of intestate succession of this state or under an of whom shall be the person who signed the advance directive for health care on behalf of and at the direction of the person making the advance directive for health care, appointed as the health care care, or by another person in the Declarant's presence and by the Declarant's expressed direction; (3) Dated; and (4) Signed in the presence of two or more witnesses at least 19 years of age, neither the capacity of a health care proxy. (c) Any advance directive for health care made pursuant to this chapter shall be: (1) In writing; (2) Signed by the person making the advance directive for healthhe Declarant's former spouse as health care proxy. (4) Under no circumstances shall the patient's health care provider or a nonrelative employee of the patient's health care provider make decisions inproxy designation or in an order of divorce, dissolution, or annulment of marriage or legal separation, the divorce, dissolution, or annulment of marriage of the Declarant revokes the designation of t shall be limited to those powers permitted under the Alabama Durable Power of Attorney Act, Section 26-1-2, as the same shall be amended from time to time. -1- (3) Unless otherwise provided in the permit a health care proxy to make general health care decisions not related to the provision, withdrawal, or withholding of life-sustaining treatment or artificially provided nutrition and hydrationall be limited to the specific directions enumerated in the appointment. (2) Any powers granted to a health care proxy in an advance directive for health care executed pursuant to this subsection thatction, provided, however, that the authority granted to an attorney-in-fact to make such decisions shall be the same as the authority granted in this chapter to a health care proxy. The appointment shnces involving terminal illness or injury and permanent unconsciousness, constitutes for purposes of this chapter a proxy designating another individual to act for the Declarant pursuant to this subseme to time, who is specifically authorized to make decisions regarding the providing, withholding, or withdrawing of life-sustaining treatment or artificially provided nutrition and hydration in instahed to the proxy designation. The proxy designation may be a separate document or part of a living will. (1) The designation of an attorney-in-fact, made pursuant to Section 26-1-2, as amended from tipecifically authorized therein. A proxy designation made pursuant to this section shall be accepted in writing by the individual being appointed. The acceptance shall be evidenced in writing and attaclife-sustaining treatment and artificially provided nutrition and hydration. Artificially provided nutrition and hydration shall not be withdrawn or withheld pursuant to the proxy designation unless smay execute at any time a living will that includes a written health care proxy designation appointing another competent adult to make decisions regarding the providing, withholding, or withdrawal of ded nutrition and hydration. Artificially provided nutrition and hydration shall not be withdrawn or withheld pursuant to the living will unless specifically authorized therein. (b) A competent adult ealth Care; living will and health care proxy. (a) Any competent adult may execute a living will directing the providing, withholding, or withdrawal of life-sustaining treatment and artificially provion Alabama Statutes Section 22-8A-4. The following are useful excerpts from the Alabama Statutes relating to the Alabama Power of Attorney for Health Care Form. Section 22-8A-4 Advance Directive for HInformation and Instructions Alabama Living Will This package contains (1) Information and Instruction for Alabama Living Will; (2) Alabama Living Will Form. This Alabama Living Will is based in part Alabama