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Preview - Texas Living Will Form
Texas Living Will Template
This Living Will is created in accordance with Texas state laws governing advance directives. It expresses one’s wishes regarding medical treatment in the event that they become unable to communicate their preferences.
Personal Information
- Name: ______________________________________
- Date of Birth: ______________________________
- Address: ____________________________________
- City: ______________________________ State: ______________ Zip Code: ___________
Declaration
I, the undersigned, being of sound mind, voluntarily make this declaration while I am still capable of making my own decisions regarding medical treatment. If I become unable to communicate my desires with regard to medical care, I direct that:
- Life-sustaining procedures be withheld or withdrawn if I have a terminal condition, irreversible condition, or if I am in a persistent vegetative state.
- I do not wish to receive cardiopulmonary resuscitation (CPR) if I am in a condition where I am unable to make my own health care decisions.
- I desire comfort care and palliative measures to be provided, regardless of the circumstance.
Appointment of Health Care Proxy
I hereby designate the following individual as my health care proxy to make any further decisions regarding my medical treatment if I become unable to do so:
- Name: ______________________________________
- Address: ___________________________________
- Phone Number: ______________________________
Effect and Revocation
This Living Will becomes effective upon my inability to communicate my health care decisions. I may revoke it at any time in writing or verbally when I am capable of making my decisions.
Signature
By signing below, I affirm that I am at least 18 years of age and am of sound mind to understand this declaration.
Signature: ________________________ Date: _____________
Witnesses
This document was witnessed by the following individuals:
- Witness 1: ___________________________ Signature: ______________________
- Witness 2: ___________________________ Signature: ______________________
This template is designed for use by Texas residents and adheres to the statutory requirements for a Living Will in the state of Texas.
Create Other Common Living Will Forms for Different States
Living Will Form Pennsylvania - Advanced directives, such as a Living Will, are recognized as important aspects of patient rights.
Advance Directives Include - Use this form to articulate your preferences regarding resuscitation efforts.
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Ahcd - This form becomes effective only when a person is unable to express their wishes due to illness or injury.
Similar forms
- Advance Directive: Similar to a Living Will, an Advance Directive outlines a person's healthcare preferences in case they become unable to communicate. It can include specific medical treatments a person does or does not want.
- Durable Power of Attorney for Healthcare: This document allows an individual to appoint someone else to make medical decisions on their behalf. While a Living Will specifies treatment preferences, a Durable Power of Attorney grants authority to another person to make those choices.
- Power of Attorney: This document allows you to authorize someone to act on your behalf in legal matters and financial decisions. It is crucial to understand the implications and responsibilities involved. For more detailed information, refer to the Power of Attorney form.
- Do Not Resuscitate (DNR) Order: A DNR order indicates that a person does not want life-saving treatments, such as CPR, in case of cardiac arrest. Like a Living Will, it reflects a person's wishes regarding end-of-life care.
- Healthcare Proxy: A Healthcare Proxy is a legal document that designates a specific individual to make healthcare decisions for someone who is incapacitated. It works in conjunction with a Living Will by providing a person to interpret and implement the documented wishes.
- Physician Orders for Life-Sustaining Treatment (POLST): This document translates a patient's preferences for life-sustaining treatment into actionable medical orders. It is similar to a Living Will but is designed for individuals with serious health conditions who may need immediate medical attention.