Alabama Living Will Template
This document serves as a Living Will, in accordance with the Alabama Advance Directive for Health Care Act. It is specifically designed to express the wishes of the undersigned regarding medical treatment in circumstances where they are no longer able to communicate their decisions themselves.
Part I: Information of the Principal
Full Name: ___________________________________________
Date of Birth: ________________________________________
Address: _____________________________________________
City: _____________________ State: AL Zip: ______________
Phone Number: _______________________________________
Part II: Directive
I, ________________ [insert your name], being of sound mind, hereby direct that my healthcare providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choices I have marked below, should I become unable to communicate my healthcare decisions due to illness or injury.
When this Living Will becomes effective: This Living Will shall become effective when my attending physician determines that I am no longer able to understand, make, or communicate my healthcare decisions and I am in any one of the following conditions:
- In a terminal condition
- In a state of permanent unconsciousness
- In a vegetative state
Life-Sustaining Treatment Choices: In the situations mentioned above, I direct the following actions to be taken concerning life-sustaining treatment:
- I wish to receive all available life-sustaining treatments, including artificially provided nutrition and hydration.
- I wish to receive life-sustaining treatments except for the following: _____________ ___________________________________________.
- I do not wish to receive any life-sustaining treatments, including artificially provided nutrition and hydration.
Part III: Signature
By signing below, I affirm that I am emotionally and mentally competent to make this Living Will and I understand its contents.
Signature: ____________________________________ Date: __________________
Witness: _____________________________________ Date: __________________
State of Alabama County of ________________
Sworn to and subscribed before me this _____ day of _________, 20___.
Notary Public: _______________________________
My Commission Expires: _______________________