$13.95

Add to cart

Oklahoma -4- _____________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ __________________________________________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ ______________________________________________ __________________________ (Signature) ___________________________________________________________ City, County and State of Residence -3- This advance directive was signed in my presence. _________________ understand the full importance of this living will and I am emotionally and mentally competent to make this living will. Signed this ___________ day of _____________, 20 _____. ______________________d. I understand that I may revoke this living will at any time. e. I understand and agree that if I have any prior living wills, and if I sign this living will, my prior living wills are revoked. f. Ieatment including, but not limited to, the administration of any life-sustaining procedures, and I accept the consequences of such refusal. c. This living will shall be in effect until it is revoked. the use of life-sustaining procedures, it is my intention that this living will shall be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical trnt and that diagnosis is known to my attending physician, this living will shall have no force or effect during the course of my pregnancy. b. In the absence of my ability to give directions regardingrwise. ______________________________________________________________________________ _______________________ (signature) IV. General Provisions a. I understand that if I have been diagnosed as pregnainted a health care proxy through any other document, and if there is a conflict between my health care proxy's decision and my living will, my living will shall take precedence unless I indicate othe/lens, [___] glands, [___] other _____________ ______________ -2- _______________________ (signature) III. Conflicting Provision I understand that if I have completed both a living will and have appoorgans or parts: [___] lungs, [___] liver, [___] pancreas, [___] heart, [___] kidneys, [___] brain, [___] skin, [___] bones/marrow, [___] bloods/fluids, [___] tissue, [___] arteries, [___] eyes/corneairculatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem. I specifically donate: [___] My entire body; or [___] The following body ransplantation, therapy, advancement of medical or dental science or research or education pursuant to the provisions of the Uniform Anatomical Gift Act. Death means either irreversible cessation of c_____________________ _______________________ (signature) II. Anatomical Gifts I direct that at the time of my death my entire body or designated body organs or body parts be donated for purposes of t_________________________________________________________________________ _________________________________________________________________________ ____________________________________________________orizing the withholding or withdrawal of artificially administered nutrition (food) and hydration (water). _______________________ (signature) (3) I direct that (add other medical directives, if any) portance. I understand that if I do not sign this paragraph, artificially administered nutrition and hydration will be administered to me. I further understand that if I sign this paragraph, I am auth (signature) (2) I understand that the subject of the artificial administration of nutrition and hydration (food and water) for individuals who have become persistently unconscious is of particular imaintain me in an irreversible condition, as determined by my attending -1- physician and another physician, in which thought and awareness of self and environment are absent. ___________________________________________ ______________________.(signature) c. If I am persistently unconscious: (1) I direct that life-sustaining treatment be withheld or withdrawn if such treatment will only serve to m___ (signature) (3) I direct that (add other medical directives, if any) _________________________________________________________________________ _____________________________________________________ered to me. I further understand that if I sign this paragraph, I am authorizing the withholding or withdrawal of artificially administered nutrition (food) and hydration (water). ____________________of dying from an incurable and irreversible condition is of particular importance. I understand that if I do not sign this paragraph, artificially administered nutrition and hydration will be administn six (6) months. _______________________ (signature) (2) I understand that the subject of the artificial administration of nutrition and hydration (food and water) that will only prolong the process d if my attending physician and another physician determine that I have an incurable and irreversible condition that even with the administration of life-sustaining treatment will cause my death withifort or to alleviate my pain. b. If I have a terminal condition: (1) I direct that life-sustaining treatment shall be withheld or withdrawn if such treatment would only prolong my process of dying, anntly Unconscious Act, to withhold or withdraw treatment from me under the circumstances I have indicated below by my signature. I understand that I will be given treatment that is necessary for my comI am no longer able to make decisions regarding my medical treatment, I direct my attending physician and other health care providers, pursuant to the Oklahoma Rights of the Terminally Ill or Persistel, that my life shall not be artificially prolonged under the circumstances set forth below. I thus do hereby declare: I. Living Will a. If my attending physician and another physician determine that _______________________________________, being of sound mind and eighteen (18) years of age or older, willfully and voluntarily make known my desire, by my instructions to others through my living wilnt should 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 -4- Living Will I, ________________ew it 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 documee to state. 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 revity 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 advice. Laws vary from time to time and from state advanced directive executed pursuant to the provisions of this section. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitabilited health care proxy, in lieu of an attending physician and other physician, to determine the lack of decisional capacity of the person. Such designation shall be specified and included as part of thdvanced directive appointing a health care proxy who may not have an attending physician for reasons based on established religious beliefs or tenets may designate an individual other than the designathority to make treatment decisions for the patient including the withholding or withdrawal of life-sustaining procedures if so indicated in the patient's advance directive. E. A person executing an aly with the advance directive, promptly so advise the Declarant. D. In the case of a qualified patient, the patient's health care proxy, in consultation with the attending physician, shall have the aulow) C. A physician or other health care provider who is furnished the original or a photocopy of the advance directive shall make it a part of the Declarant's medical record and, if unwilling to compd by two individuals who are eighteen (18) years of age or older who are not legatees, devisees or heirs at law. B. An advance directive shall be in substantially the following form: (Form included bes of age or older may execute at any time an advance directive governing the withholding or withdrawal of life-sustaining treatment. The advance directive shall be signed by the Declarant and witnesseth care provider shall make the revocation a part of the Declarant's medical record. -3- Section 3101.4 - Advance Directive Form and Procedures. A. An individual of sound mind and eighteen (18) yearndition. A revocation is effective upon communication to the attending physician or other health care provider by the Declarant or a witness to the revocation. B. The attending physician or other heal.6 - Revocation of Advance Directive. A. An advance directive may be revoked in whole or in part at any time and in any manner by the Declarant, without regard to the Declarant's mental or physical couted and not revoked, the last advance directive so executed shall be construed to be the last wishes of the Declarant and shall become operative pursuant to subsection A of this section. Section 3101 and other health care providers shall act in accordance with its provisions or comply with the provisions of Section 9 of this act. B. In the event more than one valid advance directive has been execttending physician; and 2. The Declarant is no longer able to make decisions regarding administration of lifesustaining treatment. When the advance directive becomes operative, the attending physician and another physician, result in death within six (6) months. Section 3101.5 - When Advance Directive Becomes Operative. A. An advance directive becomes operative when: 1. It is communicated to the aPuerto Rico; and 12. "Terminal condition" means an incurable and irreversible condition that, even with the administration of life-sustaining treatment, will, in the opinion of the attending physicianthe attending physician and another physician who have examined the patient; 11. "State" means a state, territory, or possession of the United States, the District of Columbia, or the Commonwealth of patient" means a patient eighteen (18) years of age or older who has executed an advance directive and who has been determined to be in a terminal condition or in a persistently unconscious state by , joint venture, government, governmental subdivision or agency, or any other legal or commercial entity; 9. "Physician" means an individual licensed to practice medicine in this state; 10. "Qualifiedan and another physician, in which thought and awareness of self and environment are absent; -2- 8. "Person" means an individual, corporation, business trust, estate, trust, partnership, associationmedical treatment deemed necessary to alleviate pain nor the normal consumption of food and water; 7. "Persistently unconscious" means an irreversible condition, as determined by the attending physiciess of dying or to maintain the patient in a condition of persistent unconsciousness. The term "life-sustaining treatment" shall not include the administration of medication or the performance of any ant has specifically authorized the withholding and withdrawal of artificially administered nutrition and hydration, that, when administered to a qualified patient, will serve only to prolong the procapable of communication; 6. "Life-sustaining treatment" means any medical procedure or intervention, including but not limited to the artificial administration of nutrition and hydration if the Declar of life-sustaining treatment if a qualified patient, in the opinion of the attending physician and another physician, is persistently unconscious, incompetent, or otherwise mentally or physically incth care proxy" is an individual eighteen (18) years old or older appointed by the Declarant as attorney-in-fact to make health care decisions including but not limited to the withholding or withdrawalprovider" means a person who is licensed, certified, or otherwise authorized by the law of this state to administer health care in the ordinary course of business or practice of a profession; 5. "Healty for the treatment and care of the patient; 3. "Declarant" means any individual who has issued an advance directive according to the procedure provided for in Section 4 of this act; 4. "Health care ct and may include a living will, the appointment of a health care proxy, or both such living will and appointment of a proxy; 2. "Attending physician" means the physician who has primary responsibili the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act: 1. "Advance directive for health care" means any writing executed in accordance with the requirements of Section 4 of this aOklahoma Rights of the Terminally Ill or Persistently Unconscious Act does not condone, authorize, or approve mercy killing, assisted suicide, or euthanasia. Section 3101.3 - Terms Defined. As used in -1- includes necessary and appropriate protection for proxies and health care providers who rely in good faith on the instructions of the individual and the decisions of an authorized proxy. C. The th care proxy. B. To be sure that the individual's health care instructions and proxy decision-making will be effective, the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act also red during incapacity without court involvement; and 5. Encourage and support health care instructions by the individual in advance of incapacity and the delegation of decision-making powers to a healother proxy is authorized by the individual or is otherwise authorized by law; 4. Restate and clarify the law to ensure that the individual's advance directive for health care will continue to be honoindividual's values and what the individual's wishes would be based upon those values. The proper role of the court is to settle disputes and to act as the proxy decision-maker of last resort when no s wishes is sufficient, those wishes should control; if there is not sufficient evidence of the individual's wishes, the proxy's decisions should be based on the proxy's reasonable judgment about the is incapacitated, so long as a proxy decision-maker can make the necessary decisions based on the known intentions, personal views, or best interests of the individual. If evidence of the individual'render care or to preserve life and health; 3. Recognize that decisions concerning one's medical treatment involve highly sensitive, personal issues that do not belong in court, even if the individualals to control some aspects of their own medical treatment is protected by the Constitution of the United States and overrides any obligation the physician and other health care providers may have to eir own medical care and treatment, including but not limited to the right to decline medical treatment or to direct that it be withdrawn, even if death ensues; 2. Recognize that the right of individue Form. Section 3101.2 - Purpose. A. The purpose of the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act is to: 1. Recognize the right of individuals to control some aspects of thart on Title 63; Chapter 60; Section 3101.2 et. Seq. of the on Oklahoma Statutes. The following are useful excerpts from the Oklahoma Statutes relating to the Oklahoma Power of Attorney for Health CarInformation and Instructions Oklahoma Living Will This package contains (1) Information and Instruction for Oklahoma Living Will; (2) Oklahoma Living Will Form. This Oklahoma Living Will is based in p Oklahoma