Fill and Sign the Definition of Power of Attorney Living Will and Advance Directives Form

ADVANCE HEALTH-CARE DIRECTIVE NOTICE TO PERSON EXECUTING THIS DOCUMENT This is an important legal document. Before executing this document, you should know these important facts: You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding the designation of your primary physician. If you use this form, you may complete or modify all or any party of it. You are free to use a different form. Part 1 of this form is a power of attorney for health care. Part 1 lets you name another individual as agent to make health care decisions for you if you become incapable of making your own decisions or if you want someone else to make those decisions for you now and even though you are still capable. You may name an alternate agent to act for you if your first choice is not willing, able or reasonably available to make decisions for you. Unless related to you, your agent may not be an owner, operator, or employee of a residential long-term health-care institution at which you are receiving care. Unless the form you sign limits the authority of your agent, your agent may make all health care decisions for you. This form has a place for you to limit the authority of your agent. You need not limit the authority of your agent if you wish to rely on your agent for all health care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to: (a) Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition; (b) Select or discharge health-care providers and institutions; (c) Approve or disapprove diagnostic tests, surgical procedures, programs or medication, and orders not to resuscitate; and (d) Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care. Part 2 of this form lets you give specific instructions about any aspect of your health care. Choices are provided for you to express your wishes regarding the provisions, withholding, or withdrawal of treatment to keep you alive, including the provision of artificial nutrition and hydration, as well as the provision of pain relief. Space is provided for you to add to the choices you have made or for you to write out any additional wishes.
The language in this form is for your and your designated alternate's personal use, not for publication. Your designated alternate may use the form for his or her own use if he or she does not object to its publication. The parties hereto acknowledge that this instrument and the information, statements and representations contained herein are intended to be read and understood as a full statement of the terms of the document for the benefit of all persons who, as of the date hereof, are authorized to execute this instrument or to act as proxy for the parties to this instrument. If you have any questions about the agreement or have questions about whether the written instrument is enforceable against the other parties, please contact either the Washington state court of king county or the court. You may ask for a copy of this instrument on paper by submitting a request to the court. The court may make a photocopy available and send a copy by certified mail. A list of Washington health-care institutions and their telephone numbers can be found by clicking here. Your written signature under this document is a full and complete agreement to waive any civil and criminal claims or causes of action which would otherwise be asserted against or otherwise against you for damages based on your acts. You may request a certified copy of this agreement by writing either the Washington state court of king county or the court; however, this written agreement will remain in effect unless revoked in writing within 60 days of its execution. Your designated alternate may revoke this written agreement in his or her discretion. In considering revoking this agreement, the designated alternate may consider your medical history and current condition as well as whether you have any known problems or illnesses that might cause you to violate the terms of this written agreement. Your designated alternate may revoke the agreement if he or she thinks your condition is so serious that the benefits of this written agreement cannot be reasonably expected to outweigh the risks. This is an informal agreement. If you enter into a written document, which states or implies that it is official, binding and enforceable in any way, no court, no attorney, no notary public, and no other individual, agency or entity will be considered to have accepted or made any contract with you that is not made in writing. In other words, any court or attorney who reads or understands this form or is told by you to sign it does so on your behalf and not on behalf of the party who signed the form, or of the agency, attorney or notary public who prepared or signed the form.