$13.95

Add to cart

Montana ______________________________ ___________________ Address: ______________________________________ _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: __________________________________________________ The declarant voluntarily signed this document in my presence. _____________________________________________ (Witness Signature) Print Name: _____________________________ Address: __________________________________________________________________ ______________________________________ Zip Code: ___________________________ Phone: ____________________________________, ______________ (month, year) _________________________________________________________________________ (Declarant's Signature) Name: _______________________________________________________Rights of the Terminally Ill Act, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary to my comfort or to alleviate pain. Signed this _____________ day of __y attending physician, cause my death within a relatively short time and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician, pursuant to the Montana Use found at findlegalforms.com Living Will DECLARATION If I should have an incurable or irreversible condition that, without the administration of lifesustaining treatment, will, in the opinion of ming matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate plannleteness. [_]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 state. These forms should only be a starting point for you 50-9-203. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or comphe attending physician and other health care providers shall act in accordance with its provisions and with the instructions of a designee under 50-9-103(1) or comply with the transfer requirements of in a terminal condition and no longer able to make decisions regarding administration of life-sustaining treatment. Information & Instructions ­ Page 3 (2) When the declaration becomes operative, t 50-9-105. When declaration operative. (1) A declaration becomes operative when: (a) it is communicated to the attending physician; and (b) the declarant is determined by the attending physician to bef it before the qualified patient is in need of life-sustaining treatment. (2) The attending physician or other health care provider shall make the revocation a part of the declarant's medical record. A revocation communicated to a person other than the attending physician, emergency medical services personnel, or a health care provider is not effective unless the attending physician is informed ocare provider or emergency medical services personnel witnessing a revocation shall act upon the revocation and shall communicate the revocation to the attending physician at the earliest opportunity.rd to mental or physical condition. A revocation is effective upon its communication to the attending physician or other health care provider by the declarant or a witness to the revocation. A health aining treatment may, but need not, be in the following form: (see form below) 50-9-104. Revocation of declaration. (1) A declarant may revoke a declaration at any time and in any manner, without regaer may presume, in the absence of actual notice to the contrary, that the declaration complies with this chapter and is valid. (2) A declaration directing a physician to withhold or withdraw life-sustr withdrawal of life-sustaining treatment. The declaration must be signed by the declarant, or another at the declarant's direction, and witnessed by two individuals. A physician or health care providrning the withholding or withdrawal of life-sustaining treatment. The declarant may designate another individual of sound mind and 18 or more years of age to make decisions governing the withholding oively short time. 50-9-103. Declaration relating to use of life-sustaining treatment -- designee. (1) An individual of sound mind and 18 or more years of age may execute at any time a declaration govel condition" means an incurable or irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of the attending physician, result in death within a relatate" means a state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, or a territory or insular possession subject to the jurisdiction of the United States. (14) "Terminace and home health Information & Instructions ­ Page 2 agencies, that signifies and certifies that a valid and current declaration is on file and that the individual is a qualified patient. (13) "Sttewide identification card or form or a necklace or bracelet of uniform design, adopted by a written, formal understanding of the local community emergency medical services agencies and licensed hospihas executed a declaration in accordance with this chapter and who has been determined by the attending physician to be in a terminal condition. (12) "Reliable documentation" means a standardized, star commercial entity. (10) "Physician" means an individual licensed under Title 37, chapter 3, to practice medicine in this state. (11) "Qualified patient" means a patient 18 years of age or older who e personnel. (9) "Person" means an individual, corporation, business trust, estate, trust, partnership, association, joint venture, government, governmental subdivision or agency, or any other legal ohod developed by the department and approved by the board, of providing palliative care to and withholding life-sustaining treatment from a qualified patient under 50-9-202 by emergency medical servicn that, when administered to a qualified patient, serves only to prolong the dying process. (8) "Living will protocol" means a locally developed, community-wide method or a standardized, statewide metuthorized by the laws of this state to administer health care in the ordinary course of business or practice of a profession. (7) "Life-sustaining treatment" means any medical procedure or interventio medical technicians, or other emergency services personnel acting within the ordinary course of their professions. (6) "Health care provider" means a person who is licensed, certified, or otherwise ant of public health and human services provided for in 2-15-2201. (5) "Emergency medical services personnel" means paid or volunteer firefighters, law enforcement officers, first responders, emergencypatient. (2) "Board" means the Montana state board of medical examiners. (3) "Declaration" means a document executed in accordance with the requirements of 50-9103. (4) "Department" means the departmen this chapter, the following definitions apply: (1) "Attending physician" means the physician selected by or assigned to the patient, who has primary responsibility for the treatment and care of the hapter 9 Section 101 et. Seq. of the Montana Code Annotated. For your convenience, we have included useful excerpts from the Montana Statutes relating to Living Wills. 50-9-102. Definitions. As used iInformation and Instructions Montana Living Will This package contains (1) Information and Instruction for Montana Living Will; (2) Montana Living Will. This Montana Living Will is based on Title 50 C Montana