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California Living Will Template
This Living Will is made in accordance with California state laws regarding advance healthcare directives. It allows you to express your wishes regarding medical treatment in the event that you are unable to communicate them yourself.
By completing this document, you will ensure that your preferences are known and respected. Please fill in the blanks where necessary.
Personal Information
Name: ___________________________
Date of Birth: ____________________
Address: _________________________
City, State, Zip: _________________
Phone Number: ___________________
Health Care Preferences
If at any time I have an incurable and irreversible condition that will result in my death within a short time period or if I become unconscious and my healthcare providers determine that I will never regain consciousness, I direct that:
- Life-sustaining treatment be withheld or withdrawn.
- I do not wish to receive food and water by feeding tube.
- Pain relief should be provided, even if it may hasten my death.
Alternate Preferences
If I am diagnosed with a terminal condition, I may also wish to consider the following:
- Do Not Resuscitate (DNR): I request that no resuscitation attempts be made.
- Palliative Care: I wish to prioritize comfort and quality of life.
Signatures
This document must be signed and dated by you and two witnesses or a notary public.
Signature: ___________________________
Date: _______________________________
Witness 1 Name: ____________________
Witness 1 Signature: ________________
Date: _______________________________
Witness 2 Name: ____________________
Witness 2 Signature: ________________
Date: _______________________________
This Living Will reflects my wishes regarding medical treatment. I revoke all prior Living Wills and designations of healthcare agents.
Form Data
| Fact Name | Description |
|---|---|
| Purpose | The California Living Will form allows individuals to express their wishes regarding medical treatment in the event they become unable to communicate their preferences. |
| Governing Law | This form is governed by the California Probate Code, specifically sections 4600 to 4806, which outline the rules for advance healthcare directives. |
| Requirements | To be valid, the form must be signed by the individual and either witnessed by two adults or notarized. |
| Revocation | Individuals can revoke their Living Will at any time, provided they do so in writing or verbally in the presence of witnesses. |
| Healthcare Agent | While the Living Will specifies treatment preferences, it can also designate a healthcare agent to make decisions on behalf of the individual if they are incapacitated. |
California Living Will - Usage Guidelines
Once you have obtained the California Living Will form, it's essential to approach it with care. This document will guide your healthcare decisions in the event that you are unable to communicate your wishes. To ensure that your preferences are clearly understood, follow the steps outlined below.
- Begin by carefully reading the entire form. Familiarize yourself with its sections to understand what information is required.
- Fill in your full name at the top of the form. Ensure that it matches your identification documents.
- Provide your date of birth. This information helps to confirm your identity.
- Next, enter your address. Include the street, city, state, and zip code.
- Designate a healthcare agent. This person will be responsible for making medical decisions on your behalf if you are unable to do so. Include their full name and contact information.
- Clearly outline your wishes regarding medical treatment. Be specific about the types of interventions you would or would not want.
- Sign and date the form at the designated area. This step is crucial as it validates your document.
- Consider having the form witnessed. California law requires that your signature be witnessed by at least one adult who is not your healthcare agent.
- Make copies of the completed form. Distribute these copies to your healthcare agent, family members, and your healthcare providers.
Some Other Living Will State Templates
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Dos and Don'ts
When filling out the California Living Will form, it's important to approach the process carefully. Here are some things to keep in mind:
- Do ensure that you clearly state your wishes regarding medical treatment.
- Don't use vague language that could lead to confusion about your intentions.
- Do sign the document in front of witnesses as required by California law.
- Don't forget to keep a copy for yourself and provide copies to your healthcare proxy and family members.
Common mistakes
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Inadequate Understanding of the Form: Many individuals do not fully comprehend the purpose of a Living Will, leading to incomplete or inaccurate information.
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Failure to Specify Preferences: Some people neglect to clearly outline their medical treatment preferences, which can result in confusion for healthcare providers.
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Not Discussing Wishes with Family: Failing to communicate intentions with family members can create misunderstandings and conflicts during critical moments.
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Omitting Signatures: A common mistake is not signing the document, which renders it invalid and unenforceable.
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Ignoring Witness Requirements: Some individuals overlook the need for witnesses, which is essential for the document's legal standing.
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Not Updating the Document: People often forget to revise their Living Will to reflect changes in their health status or personal preferences.
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Using Outdated Forms: Relying on old versions of the form can lead to legal complications, as laws and requirements may have changed.
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Neglecting to Choose an Agent: Some individuals fail to appoint a healthcare proxy, which is crucial for decision-making when they are unable to communicate.
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Not Considering All Medical Scenarios: People may overlook specific situations that could arise, leading to vague or unhelpful directives.
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Assuming the Form is Universally Accepted: Misunderstandings about where the Living Will is valid can cause issues, especially if traveling outside of California.