Advance Directive Form (Free PDF & Word)

Planning for future medical care is one of the most important decisions you can make for yourself and your family. An Advance Directive Form allows you to document your healthcare wishes before a medical emergency occurs, helping ensure that your preferences are known if you become unable to communicate or make decisions for yourself.

Many people assume that family members will automatically know what treatment they would want. Unfortunately, disagreements often arise during serious illness or injury, especially when there are no written instructions. An advance directive helps reduce uncertainty by clearly stating your wishes and identifying who should make healthcare decisions on your behalf if necessary.

In the United States, advance directives are recognized under state law, while the Patient Self-Determination Act (PSDA) of 1990 requires many healthcare providers to inform patients about their rights to make advance healthcare decisions. Because laws vary by state, the exact signing, witnessing, and notarization requirements may differ depending on where you live.

Whether you are preparing for surgery, managing a chronic condition, planning for retirement, or simply organizing your estate plan, an Advance Directive Form can provide peace of mind for both you and your loved ones.

Table of Contents

What Is an Advance Directive?

An Advance Directive is a legal document that allows you to communicate your future healthcare wishes if you become unable to make or express medical decisions.

Depending on your state’s laws, an advance directive may include:

A Living Will that states your treatment preferences.
A Medical Power of Attorney (also called a Healthcare Proxy in some states) that appoints someone to make healthcare decisions for you.
Additional healthcare instructions permitted under state law.

Some states provide a single combined form, while others use separate documents for each purpose.

Advance Directive Form Template

PDF | Word

What Is Included in an Advance Directive?

Most Advance Directive Forms include two main components:

1. Living Will

A Living Will records your preferences about medical treatment if you are terminally ill, permanently unconscious, or otherwise unable to communicate.

Common topics include:

CPR
Mechanical ventilation
Artificial nutrition and hydration
Dialysis
Pain management
Comfort care
Organ donation

2. Medical Power of Attorney / Healthcare Proxy

This section appoints a trusted person to make healthcare decisions for you if situations arise that are not specifically covered by your written instructions.

Advance Directive vs. Living Will

Feature	Advance Directive	Living Will
Broad healthcare planning document	Yes	No
Includes treatment preferences	Yes	Yes
Can appoint a healthcare agent	Yes	No
May include additional instructions	Yes	Limited
Part of an estate plan	Yes	Yes

Advance Directive vs. Medical Power of Attorney

Feature	Advance Directive	Medical Power of Attorney
May include multiple healthcare documents	Yes	No
Appoints a healthcare agent	Often	Yes
Provides treatment instructions	Often	Not necessarily
Used for broad healthcare planning	Yes	More limited

Why You Should Have an Advance Directive

Advance care planning is not only for older adults. Medical emergencies can happen at any age.

An Advance Directive can help you:

Choose who will make healthcare decisions for you.
Document your treatment preferences.
Reduce stress for family members.
Prevent disagreements among relatives.
Support your overall estate plan.
Ensure your values guide future medical care.
Provide clarity during emergencies.
Reduce the likelihood of court involvement.

Who Should Create an Advance Directive?

In general, any competent adult can benefit from having one.

Consider creating an advance directive if you:

Are 18 or older.
Are married or have children.
Own a home or have significant assets.
Have a chronic medical condition.
Are planning major surgery.
Want to reduce uncertainty for loved ones.
Are updating your estate plan.

Federal Law: The Patient Self-Determination Act

Key Federal Protection

The Patient Self-Determination Act (PSDA) of 1990 requires many healthcare facilities that participate in Medicare or Medicaid to:

Inform patients about advance directives.
Ask whether a patient has one.
Document that information in the medical record.
Educate staff and the community about advance care planning.

Important: The PSDA does not create one nationwide advance directive form. State laws still determine the legal requirements.

State Law Requirements

Advance directives are governed primarily by state law.

Requirements may vary regarding:

Witnesses
Notarization
Signing procedures
Minimum age
Mental capacity
Revocation
Recognition of out-of-state documents

General U.S. Overview

Requirement	Typical Practice
Minimum age	18+
Mental capacity	Required
Witnesses	Often 2 adults
Notarization	Required in some states
Revocation	Generally allowed while competent

Note: Always follow your state’s specific legal requirements.

Who Can Be Your Healthcare Agent?

Most states allow you to appoint a trusted adult such as:

Spouse
Adult child
Parent
Sibling
Relative
Close friend
Another trusted adult

Choose someone who understands your values and is willing to make difficult decisions if necessary.

How to Complete an Advance Directive Form

Completing an Advance Directive Form is one of the most effective ways to communicate your healthcare wishes before a medical emergency occurs. While the exact format varies by state, the general process is similar throughout the United States.

Before filling out the form, take time to think about the types of medical care you would want if you were unable to speak for yourself. Discuss your wishes with your family, healthcare provider, and the person you plan to appoint as your healthcare agent.

Step-by-Step Guide

Step	What to Do	Why It Matters
1	Download the correct form for your state	State laws and required forms differ.
2	Enter your personal information	Identifies you as the person creating the directive.
3	Choose your healthcare agent	Appoints someone to make healthcare decisions if needed.
4	Name one or more alternate agents	Provides a backup if your primary agent cannot serve.
5	Record your treatment preferences	Gives guidance about life-sustaining treatment and other healthcare decisions.
6	Review your state’s witness or notarization requirements	Ensures the document meets legal requirements.
7	Sign and date the form	Completes the document.
8	Provide copies to the appropriate people	Makes sure your directive is available when needed.

Information You’ll Need Before Completing the Form

Preparing the necessary information in advance can make the process easier and help you avoid mistakes.

Personal Information

Most forms ask for:

Full legal name
Residential address
Date of birth
Telephone number
Emergency contact (if requested)

Healthcare Agent Information

Include your chosen healthcare agent’s:

Full legal name
Address
Telephone number(s)
Email address (if requested)
Relationship to you

It is also a good idea to list one or more alternate agents.

Healthcare Preferences

Your Advance Directive may allow you to provide instructions about:

CPR (cardiopulmonary resuscitation)
Mechanical ventilation
Artificial nutrition and hydration
Dialysis
Pain management
Hospice care
Organ donation
Religious or cultural preferences
Comfort-focused care

Being as clear as possible can help your healthcare team and agent understand your wishes.

Choosing a Healthcare Agent

Selecting the right healthcare agent is one of the most important decisions in your advance care plan.

Qualities of a Good Healthcare Agent

Choose someone who:

Is at least 18 years old (or otherwise meets your state’s requirements).
Understands your healthcare values.
Can remain calm during emergencies.
Communicates effectively with doctors and nurses.
Is willing to advocate for your wishes.
Can make difficult decisions under pressure.
Is dependable and easy to contact.

Who Can Usually Serve as Your Healthcare Agent?

Person	Commonly Allowed?*
Spouse	Yes
Adult child	Yes
Parent	Yes
Sibling	Yes
Relative	Yes
Close friend	Yes
Trusted adult	Yes

*State law may impose restrictions, such as prohibiting your treating healthcare provider or certain facility employees from serving as your agent.

Witness and Notary Requirements

There is no single nationwide rule for executing an Advance Directive. Each state establishes requirements.

General U.S. Overview

Requirement	Typical Practice
Minimum age	18 or older
Mental capacity	Required
Witnesses	Often two adult witnesses
Notarization	Required in some states; optional or not required in others
Voluntary signature	Required

When Does an Advance Directive Become Effective?

Most Advance Directives become effective only when you are unable to make or communicate your own healthcare decisions.

As long as you have decision-making capacity, you continue to make your own medical choices.

When the legal standard for incapacity is met under your state’s law, your healthcare provider and healthcare agent may begin relying on your Advance Directive.

Where Should You Store Your Advance Directive?

Creating the document is only the first step. It should also be easy to locate if it is ever needed.

Best Places to Keep Copies

Location	Recommendation
Home	Keep the original in a secure but accessible place.
Healthcare agent	Provide a complete copy.
Alternate healthcare agent	Provide a copy.
Primary care physician	Ask that it be added to your medical record.
Hospital	Provide a copy if you receive ongoing treatment.
Trusted family members	Tell them where the original is stored.

Avoid placing the only original in a safe deposit box that may not be accessible during an emergency.

Updating Your Advance Directive

Your healthcare preferences may change over time. Review your Advance Directive regularly and update it when necessary.

Consider reviewing it after:

Marriage or divorce
Birth or adoption of a child
Death of your healthcare agent
Moving to another state
Diagnosis of a serious illness
Major surgery
Significant changes in your personal beliefs or treatment preferences

If you make substantial changes, it is often best to complete a new Advance Directive rather than making handwritten edits.

Revoking an Advance Directive

Most states allow you to revoke your Advance Directive as long as you have the legal capacity to do so.

Depending on state law, revocation may be accomplished by:

Destroying the document.
Signing a written revocation.
Executing a new Advance Directive.
Communicating your intent to revoke in a manner recognized by your state’s law.

After revoking your directive, notify your healthcare agent, family members, physicians, and any healthcare facilities that have copies.

Common Mistakes to Avoid

Mistake	Why It Can Be a Problem
Choosing the wrong healthcare agent	Your wishes may not be followed effectively.
Failing to discuss your preferences	Your agent may be unsure how to act.
Using the wrong state’s form	It may not satisfy local legal requirements.
Forgetting to sign or obtain required witnesses	The document could be challenged.
Not naming an alternate agent	Delays may occur if your primary agent is unavailable.
Keeping the document hidden	Healthcare providers may not know it exists.
Never updating the document	It may no longer reflect your current wishes.

Advance Directive vs. DNR Order

These documents serve different purposes and should not be confused.

Feature	Advance Directive	Do Not Resuscitate (DNR) Order
Legal document created by an individual	Yes	No
Medical order issued by a healthcare provider	No	Yes
Covers a range of healthcare decisions	Yes	No
Specifically addresses CPR	May include preferences	Yes
Used in emergencies	Yes	Yes

A DNR order addresses only whether CPR should be attempted. An Advance Directive covers broader healthcare planning.

Advance Directive vs. POLST

A POLST (Physician Orders for Life-Sustaining Treatment) form is different from an Advance Directive.

Feature	Advance Directive	POLST
Intended for all competent adults	Yes	Generally for people with serious illness or frailty, depending on state program
Completed by the individual	Yes	Completed with a healthcare provider
Expresses future wishes	Yes	Contains current medical orders
Travels with the patient	Often	Yes
Used by emergency medical personnel	May guide care	Yes, according to state law and program

Because POLST programs vary by state, ask your healthcare provider whether one is appropriate for your situation.

Conclusion

Creating an Advance Directive Form is one of the most important steps you can take to ensure your healthcare wishes are respected if you become unable to make or communicate medical decisions. Rather than leaving difficult choices to family members during an emotional time, an advance directive provides clear guidance for your healthcare team and the person you trust to act on your behalf.

Although the Patient Self-Determination Act (PSDA) encourages healthcare providers to educate patients about advance directives, the legal requirements for creating and signing these documents are established by state law. For that reason, it’s important to use the correct form for your state and follow all applicable execution requirements, including any witness or notarization rules.

Advance directives are not just for older adults or people with serious illnesses. Any competent adult can benefit from documenting their healthcare preferences and appointing a trusted healthcare agent. Reviewing your directive periodically and updating it after major life events can help ensure it continues to reflect your current wishes.

By combining an Advance Directive with other estate planning documents—such as a Medical Power of Attorney, Living Will, HIPAA Authorization, and Last Will and Testament—you can create a more complete plan that protects both your healthcare decisions and your loved ones.

FAQs

1. What is an Advance Directive Form?

An Advance Directive Form is a legal document that allows you to record your healthcare wishes and, in many states, appoint a healthcare agent to make medical decisions if you become unable to make or communicate those decisions yourself.

2. Is an Advance Directive the same as a Living Will?

Not always. An Advance Directive is a broader term that may include a Living Will, a Medical Power of Attorney (or Healthcare Proxy), and other healthcare instructions, depending on your state’s laws.

3. Who should have an Advance Directive?

Any adult who wants their healthcare preferences respected during a medical emergency or period of incapacity should consider completing an Advance Directive. It is beneficial for adults of all ages, not just seniors.

4. Do I need a lawyer to complete an Advance Directive?

Many states provide official Advance Directive forms that individuals can complete without hiring a lawyer. However, if you have complex medical, family, or estate planning concerns, consulting an attorney may be helpful.

5. Does an Advance Directive need to be notarized?

Requirements vary by state. Some states require notarization, some require witnesses, and others allow either method. Always follow the legal requirements of the state where you execute the document.

6. Can I change or cancel my Advance Directive?

Yes. In most states, you may update, replace, or revoke your Advance Directive at any time as long as you have the legal capacity to do so. After making changes, provide updated copies to your healthcare agent, healthcare providers, and anyone else who has the previous version.

7. Is an Advance Directive valid in another state?

Many states recognize Advance Directives that were validly executed in another state, but recognition and legal requirements differ. If you move permanently, review your documents to ensure they comply with your new state’s laws.

8. Where should I keep my Advance Directive?

Store the original in a secure but accessible location. Give copies to your healthcare agent, alternate agent, primary care physician, and any healthcare facilities where you regularly receive treatment. Let trusted family members know where the document is kept.

9. What happens if I do not have an Advance Directive?

If you become unable to make healthcare decisions without an Advance Directive, state law generally determines who may act on your behalf. Depending on the circumstances, disagreements among family members or court involvement may occur.

10. What documents should I prepare along with an Advance Directive?

Many people include the following documents as part of a comprehensive estate and healthcare plan:

Document	Purpose
Medical Power of Attorney	Appoints someone to make healthcare decisions on your behalf.
Living Will	States your preferences for medical treatment in specific situations.
HIPAA Authorization Form	Allows designated individuals to access your protected health information.
Last Will and Testament	Explains how your property should be distributed after your death.
Revocable Living Trust	Helps manage assets during your lifetime and after your death while potentially avoiding probate for trust assets.
Financial Power of Attorney	Authorizes someone to manage your financial affairs if you cannot do so yourself.

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