Blank Living Will Form for Pennsylvania State Fill Out Your Document

Blank Living Will Form for Pennsylvania State

A Pennsylvania Living Will form is a legal document that allows individuals to outline their preferences for medical treatment in case they become unable to communicate their wishes. This important tool ensures that your healthcare decisions are respected, even when you cannot voice them yourself. Ready to take control of your healthcare decisions? Fill out the form by clicking the button below!

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Table of Contents

Document Overview

Fact Name Details
Definition A Pennsylvania Living Will is a legal document that outlines a person's wishes regarding medical treatment in case they become unable to communicate those wishes themselves.
Governing Law The Pennsylvania Living Will is governed by the Pennsylvania Consolidated Statutes, Title 20, Chapter 54.
Requirements The form must be signed by the individual and witnessed by two adults who are not related to the individual or beneficiaries of their estate.
Revocation A Living Will can be revoked at any time. This can be done by destroying the document or by notifying healthcare providers of the decision.
Download Living Will PDF Form

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Documents used along the form

A Pennsylvania Living Will is an important document that outlines an individual's preferences for medical treatment in the event they become unable to communicate their wishes. Along with this form, several other documents can help clarify healthcare decisions and ensure that a person's preferences are honored. Below is a list of related forms and documents commonly used in conjunction with the Pennsylvania Living Will.

  • Durable Power of Attorney for Healthcare: This document allows an individual to appoint someone to make healthcare decisions on their behalf if they are unable to do so. It ensures that a trusted person can advocate for the individual’s medical preferences.
  • Advance Healthcare Directive: This combines a Living Will and Durable Power of Attorney for Healthcare into one document. It provides clear instructions for medical treatment preferences and designates a decision-maker.
  • Do Not Resuscitate (DNR) Order: This order instructs medical personnel not to perform CPR if the individual stops breathing or their heart stops. It is a specific request that can be part of broader end-of-life planning.
  • POLST (Physician Orders for Life-Sustaining Treatment): This form translates a patient’s wishes regarding life-sustaining treatments into actionable medical orders. It is typically used for individuals with serious health conditions.
  • Organ Donation Registration: This document indicates an individual's wishes regarding organ donation after death. It can be included in a Living Will or completed separately.
  • Healthcare Proxy: Similar to a Durable Power of Attorney, a healthcare proxy designates someone to make medical decisions for the individual. It is particularly important when the individual cannot express their wishes.
  • Emergency Medical Information Form: This form provides essential health information, such as allergies and current medications, to emergency responders. It can be critical in urgent situations.
  • Funeral Planning Documents: These documents outline preferences for funeral arrangements, including burial or cremation, and can ease the burden on family members during a difficult time.

Utilizing these documents alongside the Pennsylvania Living Will can provide a comprehensive approach to healthcare planning. By clearly expressing preferences and designating trusted individuals to make decisions, individuals can ensure their wishes are respected even when they cannot communicate them directly.

Document Sample

Pennsylvania Living Will

This Living Will is created in accordance with the laws of the Commonwealth of Pennsylvania, specifically addressing healthcare decisions in the event that an individual becomes unable to make those decisions themselves.

I, [Your Name], residing at [Your Address], being of sound mind, hereby declare this to be my Living Will. It is my intention that this document reflect my preferences regarding medical treatment and my wishes for end-of-life care.

In the event that I am unable to make my own healthcare decisions, I direct that my wishes be followed regarding the following:

  1. Life-Sustaining Treatment:

    I wish to receive the following forms of treatment:

    • Cardiopulmonary resuscitation (CPR): [Yes/No]
    • Mechanical ventilation: [Yes/No]
    • Tube feeding: [Yes/No]
    • Dialysis: [Yes/No]
  2. Comfort Care:

    I wish to receive care focused on comfort, which may include:

    • Pain management: [Yes/No]
    • Emotional support: [Yes/No]
  3. Organ Donation:

    Upon my passing, I wish to:

    • Donate my organs and tissues: [Yes/No]
    • Not donate my organs: [Yes/No]

This Living Will supersedes any prior living wills or advance directives. It is effective immediately and remains effective until revoked or modified in writing.

Signed on this [Date].

Signature: [Your Signature]

Witness 1: [Witness Name] Signature: [Signature]

Witness 2: [Witness Name] Signature: [Signature]

Please keep this document in a safe place and provide copies to your healthcare provider and loved ones.