Free Living Will - Montana



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DECLARATION OF LIVING WILL APPOINTMENT If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician or my attending advanced practice registered nurse, cause my death within a relatively short time and I am no longer able to make decisions regarding my medical treatment, I appoint _______________________________________, or if he or she is not reasonably available or is unwilling to serve I appoint ________________________________ in the alternative, to make decisions on my behalf regarding withholding or withdrawal of treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain, pursuant to the Montana Rights of the Terminally 111 Act. If the individual(s) I have appointed are not reasonabl

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DECLARATION OF LIVING WILL APPOINTMENT

If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician or my attending advanced practice registered nurse, cause my death within a relatively short time and I am no longer able to make decisions regarding my medical treatment, I appoint

_______________________________________, or if he or she is not reasonably available or is unwilling to serve I appoint ________________________________ in the alternative, to make decisions on my behalf regarding withholding or withdrawal of treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain, pursuant to the Montana Rights of the Terminally 111 Act. If the individual(s) I have appointed are not reasonably available or are unwilling to serve, I direct my attending physician or my attending advanced practice registered nurse, pursuant to the Montana Rights of the Terminally Ill Act, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain. Signed this_________ day of _____________________, 20_____.

Signature

Printed name Address: ______ The declarant voluntarily signed this document in my presence.

Witness Name Address:

Witness Name Address:

DECLARATION OF LIVING WILL

If I should have an incurable or irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician or my attending advanced practice registered nurse, cause my death within a relatively short time and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician or my attending advanced practice registered nurse, pursuant to the Montana Rights of the Terminally III Act, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary to my comfort or to alleviate pain.

Signed this________ day of ___________________,20____.

Signature

Printed name Address: ______ ______ The declarant voluntarily signed this document in my presence:

Witness Name Address: ______

Witness Name Address: ______ ______

File Size: 246.1 kB
Pages: 2
File Format: PDF
State: Montana
Category: Miscellaneous
Author: cs3139
Word Count: 327 Words, 2,254 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.dphhs.mt.gov/sltc/services/aging/legal/documents/livingwill.pdf