REVOCATION OF DECLARATION
OF LIVING WILL
I, ___________________________________ hereby revoke my Declaration (Living Will) regarding withholding or withdrawal of life-sustaining treatment in the event I am in a terminal condition which will result in my death in a short period of time.
This revocation is effective immediately and must be communicated to my attending physician and other health care providers as soon as possible. Dated this _________ day of _____________________, 20______.