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Preview - California Living Will Form
California Living Will Template
This document is designed for individuals in California who wish to outline their wishes regarding medical treatment if they become unable to communicate. This Living Will complies with California Probate Code Section 4701 et seq.
Please fill in the information as required.
PART 1: Personal Information
- Full Name: ______________________________________
- Date of Birth: ______________________________________
- Address: ______________________________________
PART 2: Health Care Instructions
In the event that I, [Your Full Name], find myself in a terminal condition or an irreversible condition, I want the following:
- To receive no life-sustaining treatments (including but not limited to tubes or machines) that will not improve my chances of recovery.
- To be kept comfortable through palliative care as may be required.
- To refuse artificial nutrition and hydration if I am unable to swallow.
PART 3: Designation of Health Care Agent
I designate the following individual as my health care agent:
- Name: ______________________________________
- Phone Number: ______________________________________
- Alternate Agent's Name: ______________________________________
- Alternate Agent's Phone Number: ______________________________________
PART 4: Signatures
This Living Will takes effect only when I am unable to make my own health care decisions.
By signing below, I indicate that I understand the contents of this Living Will and that it reflects my wishes.
- Signature: ______________________________________
- Date: ______________________________________
Witnesses:
- Witness 1 Signature: ______________________________________
- Witness 1 Printed Name: _______________________________
- Witness 2 Signature: ______________________________________
- Witness 2 Printed Name: _______________________________
Create Other Common Living Will Forms for Different States
How to Write a Living Will in Florida - The form is legally recognized in many states for your protection.
In addition to completing the Texas Bill of Sale, you may want to review more details about the process and requirements; for further information, visit https://pdftemplates.info/texas-bill-of-sale-form/ to ensure you have everything in order before finalizing your transaction.
Georgia Living Will - A Living Will is an essential part of comprehensive end-of-life planning.
Similar forms
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- Durable Power of Attorney for Healthcare: This allows someone to make medical decisions on behalf of another person. While a Living Will specifies treatment preferences, this document appoints a trusted individual to ensure those wishes are followed.
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- Healthcare Proxy: This document designates someone to make healthcare decisions for a person if they are unable to do so. It is similar to a Durable Power of Attorney but focuses specifically on medical choices and preferences.
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- Physician Orders for Life-Sustaining Treatment (POLST): This form translates a patient’s wishes regarding life-sustaining treatment into actionable medical orders. Like a Living Will, it communicates a person's desires about end-of-life care to medical professionals.