Advance Directive Form
All states
An advance directive form is a legal document that outlines your medical treatment preferences in case you cannot communicate or make decisions independently. A medical directive form allows you to dictate the types of medical care you want — and don’t want — so that your loved ones and healthcare providers can act following your wishes.
When Is an Advance Directive Form Used?
An advance directive form PDF provides guidance when you cannot speak for yourself due to serious illness or incapacity. It goes into effect in several situations, including:
- Serious accidents: If you're unconscious due to a car crash, head injury, or other emergency, an advance directive form guides medical teams on desired treatments.
- Terminal illness: If you’re diagnosed with a condition where survival is unlikely, an advance directive template directs whether you want to receive life-sustaining treatments like mechanical ventilation or artificial feeding.
- Progressive diseases: Conditions such as Alzheimer's or late-stage Parkinson’s disease can impair communication. Having advance directive forms ensures your care aligns with your values.
- Complications during surgery or medical treatment: If anesthesia or a medical procedure results in unexpected complications, leaving you unable to decide, your healthcare proxy can act on your behalf.
Filling out a printable advance directive before you need it provides peace of mind and prevents stressful decision-making for loved ones during critical moments.
Why Should You Create an Advance Directive?
A sample advance directive is not only for the elderly or those with serious illnesses. Every adult should consider creating one for several essential reasons:
Prevents family conflict: Family members may disagree over which treatments should be provided or withheld without explicit instructions.
Gives you control over your medical care: It ensures that your treatment preferences are respected, even if you can’t voice them at the time.
Reduces emotional burden on loved ones: Making decisions about end-of-life care can be incredibly stressful for family members. An online advance directive eliminates uncertainty.
Avoids unnecessary or unwanted medical interventions: Doctors may take all possible life-saving measures without clear instructions — even if that’s not what you would have wanted.
Ensures legal clarity: Advance directive for health care form is legally recognized in most states, helping avoid legal disputes over medical decisions.
How To Fill Out an Advance Directive Form: Step-by-Step
Creating an advance directive is straightforward with the instructions below.
Step 1: Provide your personal information
- Enter your full name.
- Provide your complete residential address.
- Confirm that you are of sound mind and aware of the document’s significance.
I, Emily Roberts, an individual having my usual place of living at 789 Maple Avenue, Chicago, IL, (the "Principal") being of sound mind and in full awareness of the significance of this document, hereby execute this Advance Directive Form (the "Directive") to express my healthcare preferences and to appoint a healthcare agent to make medical decisions on my behalf if I am unable to do so.
Step 2: Appoint a healthcare agent
A Healthcare Agent is a trusted person who will make medical decisions on your behalf if you cannot.
- Enter your agent’s full name.
- Provide their full address for identification.
- List their phone number for easy contact by healthcare providers.
- If applicable, select an alternate agent if the primary agent is unavailable.
I hereby appoint the following individual(s) as my healthcare agent(s):
Agent’s Name: Michael Carter
Agent’s Address: 452 Sunset Blvd, Los Angeles, CA
Agent’s Phone Number: (310) 555-7890
If the Agent named in this Directive is unable or unwilling to make decisions for me, I designate the following individual as an alternate agent: Sophia Mitchell, having their usual place of living at 500 Oak Street, Boston, MA.
Step 3: Define your medical care preferences
This section allows you to express your healthcare and end-of-life treatment wishes.
- Choose whether you want all life-sustaining treatments or only palliative care.
- Indicate where you prefer to receive end-of-life care.
- Specify any additional medical instructions or preferences.
I request that all life-sustaining treatments be administered, even if my condition is considered terminal.
Palliative care and pain management: I request palliative care, including pain relief and comfort care, to be provided to the greatest extent possible.
End-of-life wishes: If medically possible, I prefer to receive end-of-life care at home.
Specific wishes: No feeding tube or ventilator if recovery is unlikely.
Step 4: Declare anatomical donations (optional)
You may choose to donate your body or organs after death for medical research or transplantation.
- Indicate if you wish to donate your body.
- Specify which institution or person will receive your remains.
- Clarify the purpose of the donation.
I give: My body.
To the following persons or institutions: The hospital or medical research institution Johns Hopkins Medical Center.
For the following purposes: Any purpose authorized by law.
Step 5: Specify governing law & effectiveness
This section confirms the legal jurisdiction of the directive and when it takes effect.
Governing law and dispute resolution: This Directive shall be governed by and interpreted following the laws of the State of Illinois, and any disputes arising out of or in connection with this Directive shall be exclusively resolved by the courts of the State of Illinois.
Effective date: This Directive shall become effective immediately upon my incapacitation. This Directive shall lose effectiveness upon the Principal's death.
- Sign the simple advance directive in the presence of witnesses or a notary, if required.
- Provide copies to your healthcare agent, family, and doctor.
- Store a copy in an accessible place for medical personnel.
- Review and revise the directive if your preferences change.