Is the Five Wishes PDF legally binding?

The form can be legally binding when signed and executed according to your state's rules regarding witnesses or notarization; check your state statute for advance directive execution requirements.

Can I sign the form electronically?

Electronic signatures are generally valid under the federal ESIGN Act and state UETA laws, but some states or clinical settings may still require original wet signatures, witnesses, or notarization for advance directives.

Who should get copies of the completed form?

Provide a copy to your health care agent, primary care clinician, relevant specialists, and a trusted family member; keep a copy in an accessible place for emergencies.

What if I change my mind later?

You can update or revoke the directive at any time while competent; execute a new document and inform your agent and care providers to avoid conflicting versions.

Do I need an attorney to complete it?

An attorney is not required for most users, but consult counsel if you have complex family, medical, or asset issues where tailored language is advisable.

How do witnesses and notarization differ?

Witness requirements and notary rules vary by state; witnesses attest to your capacity, while a notary provides an official acknowledgment—both can increase acceptance by institutions.

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Advance Care Planning Five Wishes PDF

Advance Care Planning Five Wishes PDF

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Advance Care Planning — Five Wishes

RECITALS

WHEREAS, the person identified below desires to articulate health care preferences and to appoint a health care agent to make health care decisions on the person's behalf if that person lacks capacity to make or communicate decisions; and

WHEREAS, the person wishes the instructions contained in this document to be followed by physicians, health care facilities, and the appointed agent in accordance with applicable law; and

WHEREAS, the person named below intends this document to serve as an advance directive expressing health care preferences, including the Five Wishes addressing decision-making authority, treatment choices, comfort care, personal care, and final wishes.

IDENTIFICATION OF PRINCIPAL

Principal Name Date of Birth Address

Phone

Email

WISH 1 — HEALTH CARE AGENT / DURABLE POWER OF ATTORNEY FOR HEALTH CARE

I appoint the following person to serve as my primary health care agent with authority to make health care decisions for me when I am unable to make or communicate those decisions myself.

Agent (Primary) Agent Contact (Address / Phone / Email) Alternate Agent

My agent's authority to make decisions shall (select one): become effective when I am determined by my treating physician to lack capacity; become effective immediately upon execution of this document.

SCOPE OF AUTHORITY (SCOPE OF WORK)

The agent is authorized to make all health care decisions permitted by law on my behalf, including decisions about life-sustaining treatment, comfort care, mental health treatment, and hospital discharge, subject to the limitations and preferences set forth below.

Describe the scope of authority, special instructions, and any limitations the agent must observe

WISH 2 — THE KIND OF MEDICAL TREATMENT I WANT OR DO NOT WANT

If I have an incurable or irreversible condition and am likely to die, or if I am in a permanent unconscious state, I direct the following regarding life-sustaining treatment:

Attempt cardiopulmonary resuscitation (CPR) if my heart stops: Yes No

Use of mechanical ventilation if I cannot breathe on my own: Yes No

Other preferences or limitations regarding medical treatments

WISH 3 — COMFORT CARE

My priorities for comfort care are relief from pain and emotional support, even if the measures used might indirectly shorten life. I prefer the following approaches to comfort care:

Comfort care preferences

WISH 4 — HOW I WANT PEOPLE TO TREAT ME

My preferences for personal, spiritual, and interpersonal care include how visitors, caregivers, and family should interact with me and the support I want at the end of life.

Personal and spiritual preferences

WISH 5 — WHAT I WANT MY LOVED ONES TO KNOW

This wish addresses my personal messages, values, and practical directions about final arrangements, organ donation, and disposition of remains.

Personal messages and final wishes

Organ and tissue donation: Donate organs/tissues Do not donate

PAYMENT TERMS (AGENT COMPENSATION & EXPENSES)

The principal authorizes reasonable reimbursement and optional compensation to the health care agent for time and expenses incurred in carrying out duties described herein, subject to the terms below.

Compensation amount (if any) Payment schedule Late fee or interest for unpaid compensation

TERM AND TERMINATION

This appointment and directive shall become effective as indicated below and shall continue until revoked by the principal or otherwise terminated in accordance with applicable law.

Effective start date: Effective end date (optional):

Notice period for termination by principal

CONFIDENTIALITY

The agent and any successor agents shall maintain the confidentiality of the principal's medical and personal information except as necessary to carry out the duties authorized in this document, to comply with law, or to provide information to health care providers, family members, or legal advisors as reasonably necessary.

Exceptions or special confidentiality instructions

GOVERNING LAW

This document shall be governed by and construed in accordance with the laws of the state of:

ENTIRE AGREEMENT

This document constitutes the entire advance directive and expression of my health care wishes and supersedes any prior oral or written statements regarding my health care preferences, except where otherwise provided by law.

If any provision of this document is determined to be invalid or unenforceable, the remaining provisions shall remain in full force and effect to the extent permitted by law.

ATTESTATION

I declare under penalty of perjury under the laws of the governing state that I am of sound mind and that I understand the nature and effect of this directive. I appoint the person named above as my health care agent and authorize that person to act in accordance with this document.

Principal (Printed Name):

By (Signature):

Date:

Location (City, State):

Agent (Printed Name):

By (Signature):

Date:

Agent Contact at Signing:

What the Advance Care Planning Five Wishes PDF Is

The Advance Care Planning Five Wishes PDF is a widely used advance directive that lets an individual name a health care agent, describe personal, spiritual, and comfort-care preferences, and state treatment choices for end-of-life care. The form covers five practical areas: the person to make decisions, the kind of medical care desired, comfort care preferences, how family should be treated, and final wishes. While Five Wishes is a standard template, legal enforceability and execution requirements depend on state law, so many users pair it with required witnesses or notarization where applicable.

Why Complete a Five Wishes Advance Directive

Completing the Advance Care Planning Five Wishes PDF documents your health care agent and clarifies preferences for treatment and comfort, reducing uncertainty for loved ones and providers.

Who Typically Uses the Five Wishes Advance Care Plan

The form serves a broad range of adults who want to record health care preferences and appoint a decision-maker ahead of incapacity.

Older adults and people with chronic conditions who want clear instructions about life-sustaining treatment and comfort care.
Adults planning for future incapacity who wish to name a durable health care agent and provide values-based guidance.
Healthcare proxies, social workers, and care coordinators who need an accessible summary of a patient's wishes for clinical use.

Families, clinicians, and legal advisers use the completed form to guide treatment and to confirm an agent's authority when decisions are needed.

Step-by-Step: Completing the Five Wishes PDF

Follow a simple sequence to ensure the directive is complete, witnessed, and stored where clinicians can access it if needed.

01

Download or Obtain: Get the current Five Wishes PDF and read instructions carefully.
02

Fill Core Sections: Enter agent, alternates, and detailed care preferences clearly.
03

Sign, Witness, Notarize: Sign in front of required witnesses or a notary per state rules.
04

Distribute Copies: Share with agent, clinician, and family; place a copy in your medical record.

Core Parts of the Five Wishes Advance Care Planning PDF

Understanding the form's components helps you complete it thoughtfully and align directives with medical documentation and state requirements.

Who Makes Decisions

Name a primary health care agent with full contact information and authority limits to act on your behalf.

Values and Priorities

Describe personal, spiritual, and quality-of-life considerations that should guide decisions when treatment choices arise.

Treatment Preferences

State preferences about life-sustaining treatment, resuscitation, artificial nutrition and hydration, and other interventions.

Comfort and Dignity

Specify comfort-care measures, pain management wishes, and preferences for spiritual or family support.

Final Wishes

Record preferences for organ donation, funeral arrangements, and how you want loved ones to be involved.

Execution Details

Signature, date, witness or notary information, and any legally required attestation per state law.

Essential Data Elements in the Form

Full legal name: Exact name as on ID

Date of birth: MM/DD/YYYY

Agent contact: Phone and address

Treatment choices: Specific, not vague

Signatures: Signed and dated

Witness info: Witness or notary details

Risks and Consequences of Incomplete or Incorrect Forms

Invalid Signature: May render the form unenforceable

Missing Witness: State law may require witnesses

Wrong Date: Creates ambiguity about intent

Conflicting Documents: Newer directives may supersede older ones

Ambiguous Instructions: Leads to inconsistent clinical decisions

Unreachable Agent: Delays or prevents timely decision-making

Common Preparation Mistakes to Avoid

Failing to confirm your state’s witness or notarization requirements, which can invalidate the directive if not followed.
Leaving treatment preferences vague or contradictory, creating uncertainty for medical teams and the appointed agent.
Not sharing copies with the appointed agent, primary care provider, and family, so the directive is unavailable when needed.
Using outdated forms or failing to update the directive after major medical, marital, or legal changes in your life.

How Electronic Completion and Sharing Typically Works

Electronic processing streamlines completion and distribution, but must align with legal execution rules in your state.

Prepare Document: Open the PDF and enter all required fields
Add Signature Fields: Place sign and witness fields for each signer
Authenticate Signers: Use email, SMS, or stronger methods
Store and Share: Deliver copies to agent, providers, and family

Recommended Electronic Workflow Settings

Configure a simple, auditable e-signing workflow to capture signatures, witness attestations, and a tamper-evident record.

Field	Configuration
Authentication Method	Email link or SMS code; use stronger ID for RON
Signature Type	Visible e-signature with audit trail
Witness Capture	Separate fields for witness name and attestation
Storage Location	Encrypted cloud storage with access controls

Technical Requirements for eCompletion and Exchange

Use platforms that produce PDF/A-compatible signed files, offer audit trails, and support witness or notarization workflows.

File types: PDF, PDF/A or DOCX
Integrations: Works with EHRs, Google Workspace, NetSuite
Authentication: Email/SMS, KBA, or RON-capable options

Ensure any platform used can export an auditable certificate of completion and store signed files securely for later retrieval.

eSignature Pricing and Feature Comparison for Signing Five Wishes

Compare starting prices and basic capabilities for common eSignature providers when you need secure electronic completion and certificate retention for an advance directive.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day trial	Yes	Yes	Yes	Yes
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently Asked Questions about the Five Wishes PDF

Answers to common questions about completing, executing, and sharing the Five Wishes Advance Care Planning PDF in the United States.

Need help? Contact support

Is the Five Wishes PDF legally binding?
The form can be legally binding when signed and executed according to your state's rules regarding witnesses or notarization; check your state statute for advance directive execution requirements.
Can I sign the form electronically?
Electronic signatures are generally valid under the federal ESIGN Act and state UETA laws, but some states or clinical settings may still require original wet signatures, witnesses, or notarization for advance directives.
Who should get copies of the completed form?
Provide a copy to your health care agent, primary care clinician, relevant specialists, and a trusted family member; keep a copy in an accessible place for emergencies.
What if I change my mind later?
You can update or revoke the directive at any time while competent; execute a new document and inform your agent and care providers to avoid conflicting versions.
Do I need an attorney to complete it?
An attorney is not required for most users, but consult counsel if you have complex family, medical, or asset issues where tailored language is advisable.
How do witnesses and notarization differ?
Witness requirements and notary rules vary by state; witnesses attest to your capacity, while a notary provides an official acknowledgment—both can increase acceptance by institutions.

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