Free Advance Directive Template (Living Will)
Document your healthcare treatment preferences and appoint a trusted agent to make medical decisions on your behalf. Our free United States advance directive template covers life-sustaining treatment, organ donation, and more — recognized in all 50 American states.
COUNTY OF TRAVIS
| FULL LEGAL NAME | Robert James Morrison |
| DATE OF BIRTH | September 15, 1958 |
| ADDRESS | 742 Barton Springs Road, Austin, TX 78704 |
| PHONE | (512) 555-0172 |
| rmorrison@email.com |
| FULL NAME | Sarah Morrison-Park |
| ADDRESS | 1200 Congress Avenue, Austin, TX 78701 |
| RELATIONSHIP TO PRINCIPAL | Daughter |
| PHONE | (512) 555-0234 |
| sarah.park@email.com | |
| ALTERNATE AGENT | Michael Morrison · (512) 555-0345 |
If my primary agent is unable, unwilling, or unavailable to serve, I designate Michael Morrison (Phone: (512) 555-0345) as my alternate healthcare agent.
| LIFE-SUSTAINING TREATMENT | Comfort Only — focus on comfort, no aggressive treatment |
| ARTIFICIAL NUTRITION/HYDRATION | No |
| CPR | Agent Decides |
| MECHANICAL VENTILATION | Agent Decides |
| DIALYSIS | Agent Decides |
| ANTIBIOTICS | Agent Decides |
Pain Medication Preference: Maximum Relief — administer all available medication to control pain, even if it may hasten death.
Organ Donation: Yes, donate all usable organs and tissues.
Purpose: Any lawful purpose.
Quality of life matters more to me than length of life. I value dignity, independence, and being free from severe pain. I do not wish to be kept alive by artificial means if there is no reasonable expectation of recovery.
Religious/Spiritual Considerations:
I would like a chaplain or spiritual advisor to be present during end-of-life care if possible.
Specific Medical Condition Instructions:
If diagnosed with a terminal illness with a prognosis of less than 6 months, I do not wish to receive aggressive treatment. Focus on comfort care only.
Note: A POLST/MOLST (Physician/Medical Orders for Life-Sustaining Treatment) is a separate, state-specific medical order that must be signed by a physician, nurse practitioner, or physician assistant to be effective (e.g., Cal. Prob. Code § 4780 et seq.; N.Y. Pub. Health Law § 2977(13); Or. Rev. Stat. § 127.663). A Do Not Resuscitate (DNR) order is likewise a state-regulated medical directive distinct from this Advance Directive, and will be entered in my medical records only upon execution by an authorized treating clinician.
(b) Governing Law: This directive shall be governed by the laws of the State of Texas.
(c) Severability: If any provision of this directive is found invalid, the remaining provisions shall remain in full force and effect.
(d) Copies: A photocopy or electronic copy of this directive shall have the same force and effect as the original.
(e) HIPAA Personal-Representative Authorization: I authorize any healthcare provider, health plan, or clearinghouse to disclose my protected health information to my healthcare agent and alternate agent, and I designate them as my personal representatives for purposes of the HIPAA Privacy Rule, 45 C.F.R. § 164.502(g)(1)-(3), with access rights under 45 C.F.R. § 164.524. This authorization extends to all information necessary for my agent to make informed decisions on my behalf.
(f) Pregnancy: Some states impose statutory limitations on withholding or withdrawing life-sustaining treatment from a pregnant patient (see, e.g., Tex. Health and Safety Code § 166.049; applicability of such provisions has been contested since Dobbs v. Jackson Women’s Health Org., 597 U.S. 215 (2022)). To the fullest extent permitted by the law of my state, I direct that my wishes expressed above shall govern regardless of pregnancy status, unless expressly prohibited by applicable statute.
(g) Clear-and-Convincing Evidence: This directive is intended to serve as clear and convincing evidence of my wishes, as contemplated by Cruzan, 497 U.S. 261, and my state’s evidentiary standard.
On this ______ day of ________________________, 20______, before me personally appeared Robert James Morrison, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.
What Is an Advance Directive?
An advance directive is a legal document used throughout the United States that lets you put your healthcare wishes in writing while you are still able to make decisions for yourself. It takes effect only when you become incapacitated and can no longer communicate your preferences to doctors, family members, or caregivers. The document combines two key elements recognized across all U.S. states: a living will and a healthcare power of attorney.
The living will portion outlines the specific medical treatments you want or do not want in situations such as terminal illness, permanent unconsciousness, or end-stage conditions. These instructions may cover life-sustaining treatments like CPR, mechanical ventilation, artificial nutrition, dialysis, and antibiotics. The healthcare power of attorney portion designates a trusted person (called a healthcare agent or proxy) to make medical decisions on your behalf when you cannot.
Every American adult should consider creating an advance directive, regardless of age or health status. Accidents and sudden illnesses can happen at any time, and having your wishes documented ensures that your values guide your care. Without one, decisions fall to family members or U.S. state default surrogate laws, which may not reflect your actual preferences and can lead to disagreements during already difficult moments.
What's Covered in This Template
Doxuno's advance directive template includes all essential sections to document your healthcare preferences and appoint a decision-maker. Each section can be customized to match your personal values and medical wishes.
Principal Information
Healthcare Agent Appointment
Life-Sustaining Treatment
CPR and Ventilation Preferences
Artificial Nutrition and Hydration
Dialysis and Antibiotics
Pain Management Preferences
Organ Donation Wishes
Body Disposition
Religious and Spiritual Wishes
Physician Orders (POLST/DNR)
Witness and Notary Attestation
How to Create an Advance Directive
Creating an advance directive is one of the most important steps you can take to protect your healthcare wishes. Our template walks you through each section so you can complete the process in minutes. Follow these steps to build a comprehensive directive.
- 1
Enter Your Personal Information
Provide your full legal name, date of birth, address, and contact details. This identifies you as the principal creating the advance directive and ties the document to your legal identity. Accurate information ensures your directive is recognized by healthcare providers.
- 2
Appoint a Healthcare Agent
Choose a trusted person to make medical decisions when you cannot communicate. Enter their name, contact information, and relationship to you. You should also name an alternate agent in case your primary agent is unavailable. Discuss your wishes with your chosen agent before completing the form.
- 3
Specify Your Treatment Preferences
For each type of medical treatment, indicate whether you want it, do not want it, or want your agent to decide based on the situation. The template covers life-sustaining treatment, CPR, mechanical ventilation, artificial nutrition and hydration, dialysis, and antibiotics. Consider speaking with your doctor before making these decisions.
- 4
Document Additional Wishes
Record your pain management preferences, organ donation decisions, body disposition instructions, and any religious or spiritual considerations. You can also write a personal statement about your values and what quality of life means to you. These details help your agent and medical team honor your wishes.
- 5
Sign with Witnesses and Notarize
Sign the U.S. directive in front of two witnesses who are not related to you, not your healthcare agent, and not entitled to any part of your estate. Some American states also require notarization. After signing, give copies to your healthcare agent, alternate agent, doctor, and any hospital or care facility where you receive treatment.
What's Covered in This Template
Doxuno's advance directive template includes all essential sections to document your healthcare preferences and appoint a decision-maker. Each section can be customized to match your personal values and medical wishes.
This template is provided for informational purposes and does not constitute legal advice. For complex medical situations or estate planning needs, consult a licensed attorney or healthcare professional in your jurisdiction.
State-Specific Requirements
Each U.S. state has its own laws governing advance directives. While most American states recognize a standard advance directive form, some United States states have specific statutory forms that are recommended or required. Witness and notarization requirements also vary: some U.S. states require two witnesses, others require notarization, and some require both. Check your state's requirements before signing to ensure your directive will be honored throughout the United States.
When the Directive Takes Effect
An advance directive only takes effect when two conditions are met: you are unable to communicate your own healthcare decisions, and a U.S.-licensed physician has determined that you have the qualifying condition specified in the directive (such as a terminal illness, permanent unconsciousness, or end-stage condition). Until those conditions are met, you retain full decision-making authority over your own medical care under American law.
Distribution and Storage
After completing and signing your U.S. advance directive, give copies to your healthcare agent, your primary care physician, any specialists you see regularly, the hospital where you are most likely to receive care, and close family members. Keep the original in a safe but accessible location. Do not store it in a safe deposit box, as it may not be accessible in an emergency. Many American states also maintain advance directive registries where you can file a copy.
Frequently Asked Questions
Protect Your Healthcare Wishes Today
Create a comprehensive U.S. advance directive in minutes. Document your treatment preferences, appoint a healthcare agent, and give your American family the guidance they need during difficult moments.
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