MAKE THE DOCUMENT WORK FOR YOUR SITUATION
About this living will & advance care preferences draft
Record values, treatment goals, comfort priorities, and situations to discuss before completing a state living will. This editable template brings the key details into one document: your identity & family, care goals & discussion questions, agent, existing instructions & clinical review, execution plan & document custody. Complete it online, compare the live preview with your records, and download a blank or completed PDF or editable Word document.
What the template includes
The online builder and downloaded documents use the same fields. A selected state can add relevant research prompts. Complete only applicable items; add explanations for exceptions rather than assuming a blank entry resolves them.
Document details4 inputs +
Set the date, jurisdiction, and your internal reference.
- Document date *
- US state *
- County
- Document reference
Your identity & family9 inputs +
Identify the person making the plan and anyone affected by it.
- Your full legal name *
- Prior names
- Date of birth
- Home address *
- Marital status
- Spouse or partner name
- Children, dates of birth, and relationships
- Other dependents and care needs
- Citizenship or cross-border considerations
Care goals & discussion questions11 inputs +
Document preferences without substituting for a clinical assessment.
- What matters most in your care *
- Outcomes you consider unacceptable
- Preferences when prognosis is uncertain
- Time-limited treatment trial preferences
- Resuscitation questions for your clinician
- Ventilation preferences to discuss
- Artificial nutrition preferences to discuss
- Artificial hydration preferences to discuss
- Dialysis preferences to discuss
- Comfort and symptom-relief priorities *
- Spiritual and cultural support
Agent, existing instructions & clinical review8 inputs +
A preference document is different from an emergency medical order.
- Health care agent name and contact *
- Alternate contact
- Existing directive location and date
- Existing DNR or POLST and signing clinician
- Clinician to discuss preferences with
- Clinical discussion date
- Preferred care setting
- Recipients of final directive
Execution plan & document custody9 inputs +
Record a plan for the final state-compliant instrument. These fields do not certify validity.
- Planned legal reviewer
- Proposed witness 1 name and contact
- Proposed witness 2 name and contact
- Witness eligibility checks
- Notary or acknowledgment arrangements
- Required notices or statutory wording to verify
- Where the original will be kept
- People and institutions to receive copies
- Next review date
Florida official health directive review6 inputs +
Florida AHCA supplies living-will and surrogate forms. These are separate from a financial POA and clinician medical orders.
- Relevant AHCA living-will or surrogate form version
- Final instruction or surrogate instrument selected
- Two-witness and relationship eligibility checks for final form
- Surrogate appointment and alternate role review
- Comparison with existing care instructions and clinician orders
- Clinical discussion findings to transfer to the final form
How to complete it
1. Document details
Set the date, jurisdiction, and your internal reference. Review document date, us state, county, document reference against your source records.
2. Your identity & family
Identify the person making the plan and anyone affected by it. Review your full legal name, prior names, date of birth, home address and the remaining details against your source records.
3. Care goals & discussion questions
Document preferences without substituting for a clinical assessment. Review what matters most in your care, outcomes you consider unacceptable, preferences when prognosis is uncertain, time-limited treatment trial preferences and the remaining details against your source records.
4. Agent, existing instructions & clinical review
A preference document is different from an emergency medical order. Review health care agent name and contact, alternate contact, existing directive location and date, existing dnr or polst and signing clinician and the remaining details against your source records.
5. Execution plan & document custody
Record a plan for the final state-compliant instrument. These fields do not certify validity. Review planned legal reviewer, proposed witness 1 name and contact, proposed witness 2 name and contact, witness eligibility checks and the remaining details against your source records.
6. Florida official health directive review
Florida AHCA supplies living-will and surrogate forms. These are separate from a financial POA and clinician medical orders. Review relevant ahca living-will or surrogate form version, final instruction or surrogate instrument selected, two-witness and relationship eligibility checks for final form, surrogate appointment and alternate role review and the remaining details against your source records.
Practical tips
- Explain the outcomes and values behind preferences; treatment names alone may be ambiguous.
- Ask the clinician whether a separate medical order is appropriate for your current situation.
Before signing or submitting
This is a planning and attorney-review draft, not an execution-ready statutory form. It has not been reviewed by a lawyer. State law can require particular wording, notices, witnesses, notarization, capacity, disclosures, or court procedures. Use the linked official form when appropriate and obtain jurisdiction-specific review before signing.