$23.95

Add to cart

New York ________________ _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ 2 arant, nor am I a health care agent of the Declarant. _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________larant. I did not sign the Declarant's signature above for or at the direction of the Declarant. At the date of this instrument, I am not a beneficiry entitled to any portion of the estate of the Decllarant sign the declaration in my presence (or the Declarant acknowledged in my presence that he or she had signed the declaration) and I signed the declaration as a witness in the presence of the Dec______________________ ______________________________________ Zip Code: ___________________________ The Declarant is personally known to me and I believe him or her to be of sound mind. I saw the Decl import of this declaration. Date: _________________________________ Signature: _________________________________________________________________ Address: ____________________________________________eatment, under the law of New York. I intend my instructions to be carried out, unless I have rescinded them in a new writing or by clearly indicating that I have changed my mind. I understand the ful______________________________________________________________________ ____________________________________________________________________________ These directions express my legal right to refuse trics. However, I do want maximum pain relief, even if it may hasten my death. 1 Additional Instructions (optional): ____________________________________________________________________________ ______tatement with which you do not agree): I do not want cardiac resuscitation. I do not want artificial or mechanical respiration. I do not want artificial nutrition and hydration. I do not want antibiotm not legally required to be specific about future treatments if I am in the condition(s) described above I feel especially strongly about the following forms of treatment (cross out and initial any st I direct that my treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing treatment. While I understand that I aI am in a permanent coma or persistent vegetative state which is an irreversible condition in which I am at no time aware of myself or the environment and show no behavioral response to the environmenition which, without the administration of life support systems, will, in the opinion of my attending physician, result in death within a relatively short time. By permanently unconscious I mean that scious but have irreversible brain damage and will never regain the ability to make decisions and express my wishes. By terminal condition, I mean that I have an incurable or irreversible medical condersible mental or physical condition with no reasonable expectation of recovery. These instructions apply if I am (a) in a terminal condition; (b) permanently unconscious; or (c) if I am minimally conline medical treatment under the circumstances indicated below: I direct my attending physician to withhold or withdraw treatment that merely prolongs my dying, if I should be in an incurable or irrevily make this statement as a directive to be followed if I become permanently unable to participate in decisions regarding my medical care. These instructions reflect my firm and settled desire to decject to the Disclaimers and Terms of Use found at findlegalforms.com Living Will DECLARATION I, __________________________________________________________, being of sound mind, willfully and voluntarmended when dealing with estate planning 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 subould only be a starting point for you 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 recome 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 state. These forms shnt. The document does not have to be notarized. [_] 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 purposses should know the nature of the document being signed and be able to attest that Declarant was of sound mind, under no duress, and understood the nature, and consequences of execution, of the documer. Neither witness can be a person appointed as a health care agent, or a distributee of the Declarant or beneficiary under his or her Will (so that would benefit by the declarant's death). The Witnes in some form of writing like for example a `Living Will Declaration' The Living will should be properly executed by the Declarant and it should also be signed by two witnesses who are eighteen or ove County Medical Center the Court established the need for "clear and convincing" evidence of a patient's wishes and stated that the "ideal situation is one in which the patient's wishes were expressedot personally communicate those wishes. Some of the standards have been set forth in cases like In re Westchester County Medical Center, 72 N.Y.2d 517 (1988) and many other cases. In In re Westchestered in New York, they are recognized by New York courts as the best evidence of an individual's wishes concerning medical treatment in the event that treatment is proposed at a time when he or she cannstructions New York Living Will This package contains (1) Information and Instruction for New York Living Will; (2) New York Living Will. Although Living Will Declarations are not statutorily authoriz__________________ Print Name of Witness 2 _______________________________________________ Address_____________________________________________________________ Page 2 Living Will Information and In______ Print Name of Witness 1 _______________________________________________ Address ____________________________________________________________ Signature of Witness 2 _____________________________d mind and acting of his or her own free will. He or she signed (or asked another to sign for him or her) this document in my presence. Signature of Witness 1 _________________________________________ses (Witnesses must be 18 years of age or older and cannot be the health care agent or alternate) I declare that the person who signed this document is personally known to me and appears to be of soun________________________________________ Address _____________________________________________________________ Date________________________________________________________________ Statement by Witnes__________________ ________________________________________________________________________ ________________________________________________________________________ 5. Signature of Principal _________ravenous line), your agent must reasonably know your wishes. You can either tell your agent what your wishes are or include them in this section. ______________________________________________________________________________________________ In order for your agent to make health care decisions for you about artificial nutrition and hydration (nourishment and water provided by feeding tube and intnce with the following limitations and/or instructions (attach additional pages as necessary): ________________________________________________________________________ ________________________________authority to make health care decisions for you or to give specific instructions, you may state your wishes or limitations here.) I direct my health care agent to make health care decisions in accorda____________ 4. Optional: I direct my health care agent to make health care decisions according to my wishes and limitations, as he or she knows or as stated below. (If you want to limit your agent's hall expire (if you want this proxy to expire specific date or conditions, if desired): ____________________________________________________ ___________________________________________________________ Unless I revoke it, or state an expiration date or circumstances under which it will expire, this proxy shall remain in effect indefinitely, or until the date or conditions stated below. This proxy snt) ________________________________________________________________________ as my health care agent to make any and all health care decisions for me, except to the extent that I state otherwise. 3. unable, unwilling or unavailable to act as my health care agent, I hereby appoint ___________________________________________________________ (name, home address and telephone number of Alternate Agexcept to the extent that I state otherwise. This proxy shall take effect only when and if I become unable to make my own health care decisions. 2. Optional: Alternate Agent If the person I appoint is(name, home address and telephone number of Agent) ________________________________________________________________________ as my health care agent to make any and all health care decisions for me, eCare Proxy Form Power of Attorney for Health Care 1. I, __________________________________________________________, Principal hereby appoint __________________________________________________________ with a tax professiona l. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Power of Attorney for Health Care New York State Health your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussedice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fitseen made or are provided as to their suitability for 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 advHealth Care Directive. The first form is the Power of Attorney for Health Care and the second form is the Living Will. [_] These forms are provided "as is" and no implied or express warranties have bNew York Advance Health Care Directive This package contains both a New York Power of Attorney for Health Care and a New York Living Will. Together these forms are also sometimes known as an Advance New York