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Georgia Living Will

This Living Will is created in accordance with Georgia law, specifically O.C.G.A. § 31-32-5. It allows you to express your preferences regarding medical treatment in case you become unable to communicate your wishes.

By signing this document, you are indicating your wishes about end-of-life care. Please fill out the information below:

Personal Information

  • Name: __________________________
  • Address: __________________________
  • City, State, ZIP: __________________________
  • Date of Birth: __________________________

Declaration

If I enter a state of terminal illness or become permanently unconscious, I wish to make the following instructions concerning my medical care:

  1. Do Not Resuscitate (DNR): I desire to have no attempts made to revive me if my heart stops or I stop breathing.
  2. Life-Sustaining Treatment: I request that life-sustaining treatments be withheld or withdrawn under the following conditions: __________________________.
  3. Artificial Nutrition and Hydration: I wish to receive/withhold artificial nutrition and hydration under the following circumstances: __________________________.

Appointment of Health Care Agent

I designate the following person as my health care agent to make decisions on my behalf regarding my medical treatment if I cannot communicate:

  • Name of Agent: __________________________
  • Address: __________________________
  • Phone Number: __________________________

Signature

This Living Will reflects my wishes. I understand that I can revoke it at any time, and it is valid through the laws of Georgia.

Signed on this _____ day of ____________, 20__.

Signature: __________________________

Witnesses

Two witnesses must sign below to validate this Living Will. Neither witness may be the designated health care agent.

  1. Witness 1: __________________________
  2. Witness 2: __________________________
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Similar forms

  • Advance Directive: This document outlines a person's preferences for medical treatment in situations where they cannot communicate their wishes. Like a Living Will, it provides guidance to healthcare providers and family members regarding end-of-life care.
  • Durable Power of Attorney for Healthcare: This form allows an individual to designate someone else to make healthcare decisions on their behalf. While a Living Will specifies treatment preferences, this document empowers another person to make those decisions when necessary.
  • Do Not Resuscitate (DNR) Order: A DNR order instructs medical personnel not to perform CPR if a patient stops breathing or their heart stops. It is similar to a Living Will in that it expresses a person's wishes regarding life-sustaining treatment.
  • Healthcare Proxy: This document appoints an individual to make medical decisions for someone who is incapacitated. It complements a Living Will by ensuring that someone is available to interpret and act on the wishes expressed in the Living Will.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that specifies the types of life-sustaining treatments a patient wishes to receive. It is similar to a Living Will but is intended for patients with serious illnesses or those nearing the end of life.
  • Do Not Intubate (DNI) Order: A DNI order indicates that a patient does not want to be intubated if they cannot breathe on their own. This aligns with the goals of a Living Will by expressing preferences regarding invasive procedures.
  • Organ Donation Form: This document allows individuals to express their wishes regarding organ donation after death. Like a Living Will, it addresses end-of-life decisions and reflects personal values and choices.
  • Mental Health Advance Directive: This form outlines a person's preferences for mental health treatment during a crisis. Similar to a Living Will, it provides guidance when the individual is unable to communicate their needs.
  • Mobile Home Bill of Sale: Essential for documenting the sale or purchase of mobile homes, the Washington Mobile Home Bill of Sale form serves to provide both buyers and sellers with a legal record of ownership change, much like the Auto Bill of Sale Forms which facilitate vehicle transactions.
  • End-of-Life Care Plan: This comprehensive plan includes a person's preferences for all aspects of end-of-life care, including medical treatment, comfort measures, and spiritual considerations. It serves a similar purpose to a Living Will by ensuring that wishes are honored.