Skip to main content

Administrative — Living Will (Advance Directive)

Administrative Primary Care Updated: 1/4/2026

Advance Medical Directive (Living Will) template. Document end-of-life care preferences, life support, and hydration/nutrition choices. Essential for patient care planning.

Template

LIVING WILL / ADVANCE DIRECTIVE I, [Patient Name], being of sound mind, make this statement as a directive to be followed if I become permanently unable to participate in decisions regarding my medical care. 1. Life-Sustaining Treatment:

If I am in a terminal condition or permanent unconscious state:
[ ] I WANT life-sustaining treatment (CPR, ventilator) to prolong my life.
[ ] I DO NOT WANT life-sustaining treatment. I wish to be allowed to die naturally.

2. Artificial Nutrition and Hydration:

[ ] I WANT artificial nutrition and hydration.
[ ] I DO NOT WANT artificial nutrition and hydration.

3. Pain Relief:

I direct that I be given medication to make me comfortable and relieve pain, even if it may shorten my life.

4. Additional Instructions:

[Enter specific wishes here, e.g., religious preferences, organ donation]

5. Surrogate Decision Maker:

If I am unable to make decisions, I designate the following person as my agent:
* Name: [Agent Name]
* Phone: [Agent Phone]

Signature: __________________________ Date: _____________

[Patient Name]

Witness 1: __________________________ Witness 2: __________________________

💡 Tip: Click anywhere to edit. Changes are temporary.

Related templates

Automate Your Documentation

Use this template with OrbVoice AI medical scribe to automatically generate structured notes from patient conversations. Save 2+ hours daily while maintaining documentation quality.

Related resources