Advance directive for health care requires two witnesses at least 19 years old. Not valid if pregnant.
Durable Power of Attorney
No Official State Form
HIPAA: Authorization
https://www.alabamapublichealth.gov/compliance/assets/chr6authreleaseinfo.pdf
Medical Directives
https://www.alabamapublichealth.gov/ems/assets/dnar.form.010317.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.adph.org/ems/assets/DNAROrder.pdf
Disposition of Remains Authorization Information
https://fsb.alabama.gov/wp-content/uploads/2022/11/AUTHORIZING.AGENT_.AFFIDAVIT.pdf
Living will requires no witnesses. Two witnesses are required for a “health care proxy,” but this allows only general medical decisions to be made.
Durable Power of Attorney
https://courts.alaska.gov/shc/family/docs/poa-booklet.pdf
HIPAA: Authorization
https://health.alaska.gov/dph/Nursing/Documents/Registration%20Forms/Release%20of%20Information.pdf
Medical Directives
https://health.alaska.gov/dph/Director/Documents/advancedirective.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.asmadocs.org/assets/docs/Promotional/AK%20POLST_Patient%20Guide
Disposition of Remains Authorization Information
Disp. of remains form exists but no free copy could be found
One witness or a notary is required for a living will, as well as for a health care power of attorney. For disposition of remains the only way to make sure your wishes are carried out is to put them in writing as the written wishes of the decceased carry more weight than the survivors.
Durable Power of Attorney
No Official State Form
HIPAA: Authorization
https://des.az.gov/sites/default/files/legacy/dl/PPP-1127A.pdf?time=1677810118644
Medical Directives
https://www.azcourts.gov/selfservicecenter/Powers-of-Attorney
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.azag.gov/sites/default/files/docs/seniors/life-care/2018/LCP_Packet_fillable-DNR.pdf
Disposition of Remains Authorization Information
No Official State Form
Living Wills and Health Care Directives Act, Ariz. Rev. Stat. Ann. §§ 36-3201 to 36-3262
Both living wills and health care proxies require two witnesses. Not valid if pregnant.
Durable Power of Attorney
No Official State Form
HIPAA: Authorization
No Official State Form
Medical Directives
https://www.healthy.arkansas.gov/programs-services/topics/health-care-decision-forms
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.healthy.arkansas.gov/images/uploads/pdf/POLST_Form_and_Directions.pdf
Disposition of Remains Authorization Information
https://funerals.org/wp-content/uploads/2017/01/Arkansas-RightOfDispositionForm.pdf
Durable Power of Attorney for Health Care Act, Ark. Code Ann. § 20-13-104
Rights of the Terminally Ill or Permanently Unconscious Act, Ark. Code Ann. §§ 20-17-201 to 20-17-217
An advance health care directive and a durable power attorney require two witnesses OR a notary, but are not valid if pregnant. This forms contains a LW, Dir to physician, and organ donation.
Durable Power of Attorney
https://www.ftb.ca.gov/tax-pros/power-of-attorney/index.html
HIPAA: Authorization
https://eforms.com/images/2016/10/California-HIPAA-Medical-Release-Form.pdf
Medical Directives
https://www.healthy.arkansas.gov/programs-services/topics/health-care-decision-forms
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.courts.ca.gov/documents/Advanced-HealthCare-Directive-Form_031620.pdf
Disposition of Remains Authorization Information
https://www.cfb.ca.gov/enforcement/1705form.pdf
California Health Care Decisions Law, Cal. Prob. Code §§ 4600 to 4805
Health care declaration (living will) requires two witnesses, but is not valid if pregnant. Medical durable power of attorney for health care does NOT require any witnesses or notary. Colorado used to have their OOHDNR on a blue form printed privately. Their laws allow anyone to write and it does not need to be on a “state” document. Certain info must be on the form. This one meets all the requirements-
Durable Power of Attorney
https://www.sos.state.co.us/pubs/info_center/laws/Title15/powerOfAttorney.pdf
HIPAA: Authorization
https://hcpf.colorado.gov/sites/hcpf/files/Designation%20of%20Personal%20Representative.pdf
Medical Directives
https://cdphe.colorado.gov/palliative-care/advance-care-planning-for-patients-and-families
Physician’s Orders for Life Sustaining Treatment (POLST)
https://senioranswers.org/wp-content/uploads/2020/04/CPR-Form.pdf
Disposition of Remains Authorization Information
No Official State Form
Medical Treatment Decision Act, Colo. Rev. Stat. §§ 15-18-101 to 15-18-113
Patient Autonomy Act, Colo. Rev. Stat §§ 15-14-501 to 15-14-509
Advance directive (inclusive of a living will, or an appointment of health care representative, or both) requires two witnesses. Not valid if pregnant. This version includes: Appointment of a HC rep, Living Will and HC instruct. Doc. Anatomical Gift Designation of a Conservator. DNR order form attests DNR was completed in hospital and transfers.
Durable Power of Attorney
https://portal.ct.gov/DRS/DRS-Forms/Miscellaneous-Forms/Power-of-AttorneyDisclosure-Forms
HIPAA: Authorization
No Official State Form
Medical Directives
Physician’s Orders for Life Sustaining Treatment (POLST)
Disposition of Remains Authorization Information
https://www.cga.ct.gov/2018/act/pa/2018PA-00153-R00SB-00467-PA.htm
All in 1 form. 1 form all environments for CPR.
Durable Power of Attorney
https://courts.delaware.gov/help/poa.aspx
HIPAA: Authorization
https://scpd.delaware.gov/pdfs/Medical-Information-Release-Form.pdf
Medical Directives
https://www.dhss.delaware.gov/dsaapd/files/advancedirective.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://regulations.delaware.gov/register/september2017/4304%20DMOST%20form.pdf
Disposition of Remains Authorization Information
Advance health-care directive (includes an individual instruction or a power of attorney for health care, or both) requires two witnesses.
Durable Power of Attorney
https://otr.cfo.dc.gov/sites/default/files/dc/sites/otr/publication/attachments/2005062016.pdf
HIPAA: Authorization
https://doc.dc.gov/sites/default/files/dc/sites/doc/page_content/attachments/HIPAA.pdf
Medical Directives
https://www.inova.org/sites/default/files/2019-04/eng-dc-adv-dir.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
Disposition of Remains Authorization Information
https://funerals.org/wp-content/uploads/2017/01/District-of-Columbia-Designated-Agent-Form.pdf
Health-Care Decisions Act, Del. Code Ann. tit. 16, §§ 2501 to 2518 “Natural Death Act, D.C. Code Ann. §§ 6-2421 to 6-2430
Health-Care Decisions Act, D.C. Code Ann. §§ 21-2201 to 21-2213″
Two witnesses or a notary are required for an advance directive or appointment of a health care agent.
Durable Power of Attorney
https://www.floridabar.org/public/consumer/pamphlet13/
HIPAA: Authorization
Medical Directives
https://quality.healthfinder.fl.gov/reports-guides/advance-directives.aspx
Physician’s Orders for Life Sustaining Treatment (POLST)
https://polstfl.org/wp-content/uploads/2017/12/POLST-Form-July-10-2015.pdf
Disposition of Remains Authorization Information
No Official State Form
Lady Bird Deeds/Enhanced
Yes
Health Care Advance Directives Act, Fla. Stat. Ann. §§ 765.101 to 765.404
Official Code of Georgia (O.C.G.A.) at Section 31-21-7.
Durable Power of Attorney
https://georgia.gov/establish-power-attorney
HIPAA: Authorization
https://armhc.org/wp-content/uploads/2021/05/Georgia-HIPAA-Medical-Release-Form.pdf
Medical Directives
https://www.fcs.uga.edu/docs/Georgia_Advance_Directive_for_Healthcare_Form.doc
Physician’s Orders for Life Sustaining Treatment (POLST)
https://dph.georgia.gov/sites/dph.georgia.gov/files/POLSTRevised_LJ_8_21_2014.docx
Disposition of Remains Authorization Information
No specific forms; State code on how arrange.
Durable Power of Attorney
https://www.capitol.hawaii.gov/hrscurrent/vol12_ch0501-0588/HRS0551E/HRS_0551E-0051.htm
HIPAA: Authorization
TBD
Medical Directives
https://health.hawaii.gov/eoa/files/2013/04/AHCD.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://kokuamau.org/wp-content/uploads/POLST-Forms-Hawaii-for-web.png
Disposition of Remains Authorization Information
No witnesses required for a “Living Will and Durable Power of Attorney for Health Care.” Not valid if pregnant. Optional submission to state registry.
Durable Power of Attorney
https://isb.idaho.gov/wp-content/uploads/tax_pwratty2012.pdf
HIPAA: Authorization
No Official State Form
Medical Directives
https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=21779&dbid=0&repo=PUBLIC-DOCUMENTS
Physician’s Orders for Life Sustaining Treatment (POLST)
https://intermountainhealthcare.org/ckr-ext/Dcmnt?ncid=520443979
Disposition of Remains Authorization Information
No Official State Form
Natural Death Act, Idaho Code §§ 39-4501 to 39-4509
2 witnesses only.
Durable Power of Attorney
https://www.illinois.gov/content/dam/soi/en/web/gac/forms/documents/poa-property-july2011.pdf
HIPAA: Authorization
https://www.dhs.state.il.us/onenetlibrary/12/documents/Forms/IL462-0146.pdf
Medical Directives
Physician’s Orders for Life Sustaining Treatment (POLST)
Disposition of Remains Authorization Information
No Official State Form
Durable Power of Attorney
No Official State Form
HIPAA: Authorization
No Official State Form
Medical Directives
https://www.in.gov/dcs/files/all_health_care_forms_for_DCS_wards.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://forms.in.gov/Download.aspx?id=5596
Disposition of Remains Authorization Information
No Official State Form
Durable Power of Attorney
https://iowaaging.gov/sites/default/files/library-documents/FinancialPowerofAttorney_Brochure.pdf
HIPAA: Authorization
No Official State Form
Medical Directives
https://hhs.iowa.gov/sites/default/files/470-3948.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
Disposition of Remains Authorization Information
https://www.ilesfuneralhomes.com/files/3714/4909/8231/declaration-final-disposition.pdf
Durable Power of Attorney
http://kslegislature.org/li_2012/b2011_12/statute/058_000_0000_chapter/058_006_0000_article/
HIPAA: Authorization
Medical Directives
https://www.kdhe.ks.gov/1330/Advance-Care-Planning
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.kansaslegalservices.org/sites/kansaslegalservices.org/files/DNRform.pdf
Disposition of Remains Authorization Information
No Official State Form
Natural Death Act, Kan. Stat. Ann. §§ 65-28,101 to 65-28,109
Durable Power of Attorney for Health Care Decisions Act, Kan. Stat. Ann. §§ 58-625 to 58-632
Durable Power of Attorney
No official state form except for when dealing with the state revenue service.
HIPAA: Authorization
https://education.ky.gov/AA/distsupp/Documents/Form%20HIPAA.pdf
Medical Directives
https://www.chfs.ky.gov/agencies/dail/Documents/Livingwill.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.oldhamcountyems.com/uploads/1/2/7/1/127107410/ky_do_not_resuscitate_form.pdf
Disposition of Remains Authorization Information
https://kbefd.ky.gov/New%20Forms/Updated%20Funeral%20Planning%20Declaration.pdf
Durable Power of Attorney
https://louisianalawhelp.org/resource/power-of-attorney-poa
HIPAA: Authorization
LA does not provide forms.
Medical Directives
LA does not provide forms.
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.polst.org/wp-content/uploads/2013/01/LaPOST-Handbook-for-Health-Care-Professionals.pdf
Disposition of Remains Authorization Information
LA does not provide forms.
Advance health care directives require two witnesses.
Durable Power of Attorney
https://mainelse.org/handbook/planning-future/powers-attorney
HIPAA: Authorization
No form for caregivers.
Medical Directives
https://www.maine.gov/ag/dynld/documents/AHCD_Form_July20_2004.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://mainehospicecouncil.org/about-us/polst-maine-physician-orders-for-life-sustaining-treatment
Disposition of Remains Authorization Information
No Official State Form.
Uniform Health-Care Decisions Act, Me. Rev. Stat. Ann. tit. 18-A, §§ 5-801 to 5-817
Powers of Attorney Act, Me. Rev. Stat. Ann. tit. 18-A §§ 5-501 to 5-506
Durable Power of Attorney
https://www.marylandattorneygeneral.gov/courts%20documents/17-202.pdf
HIPAA: Authorization
No general state form.
Medical Directives
https://www.marylandattorneygeneral.gov/health%20policy%20documents/adirective.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://marylandmolst.org/docs/MOLST2021714.pdf
Disposition of Remains Authorization Information
No Official State Form.
Durable Power of Attorney
No Official State Form.
HIPAA: Authorization
Medical Directives
https://www.honoringchoicesmass.com/who-s-your-agent-program/
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.honoringchoicesmass.com/who-s-your-agent-program/
Disposition of Remains Authorization Information
Durable Power of Attorney
No Official State Form.
HIPAA: Authorization
No Official State Form.
Medical Directives
https://www.uofmhealth.org/patient-visitor-guide/advance-directives
Physician’s Orders for Life Sustaining Treatment (POLST)
No Official State Form.
Disposition of Remains Authorization Information
Durable Power of Attorney
https://www.ag.state.mn.us/consumer/handbooks/probate/PowerOfAtty.pdf
HIPAA: Authorization
https://www.health.state.mn.us/facilities/notices/docs/consent.pdf
Medical Directives
https://extension.umn.edu/health-care/minnesota-health-care-directive-planning-toolkit
Physician’s Orders for Life Sustaining Treatment (POLST)
https://mn.gov/emsrb/assets/POLST%20Form_MN_FINAL%202017-03.13_tcm21-283534_tcm1116-368779.pdf
Disposition of Remains Authorization Information
Durable Power of Attorney
Only POA state form is for MS revenue dept.
HIPAA: Authorization
No Official State Form.
Medical Directives
https://www.nrc-pad.org/images/stories/PDFs/mississippi_hcpa.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.msbml.ms.gov/sites/default/files/Documents/Verification/POST_Form.pdf
Disposition of Remains Authorization Information
No Official State Form.
Example forms available through funeral homes.
Durable Power of Attorney
No general POA state form.
HIPAA: Authorization
https://dss.mo.gov/cd/info/forms/pdf/ss6.pdf
Medical Directives
Physician’s Orders for Life Sustaining Treatment (POLST)
https://health.mo.gov/safety/ems/pdf/dnrauthorizationbw.pdf
Disposition of Remains Authorization Information
No Official State Form.
Directive includes Med. Dec maker, advanced directives organ donation, Dispos. of Remains;. there is a state registry POLST form must be printed on a light green form.
Durable Power of Attorney
https://leg.mt.gov/bills/mca/title_0720/chapter_0310/part_0030/section_0530/0720-0310-0030-0530.html
HIPAA: Authorization
No Official State Form.
Medical Directives
Physician’s Orders for Life Sustaining Treatment (POLST)
https://dphhs.mt.gov/assets/publichealth/EMSTS/MontanaPOLSTForm.pdf
Disposition of Remains Authorization Information
https://apps.msuextension.org/montguide/guide.html?sku=MT200918HR
Two witnesses required for a living will. Durable power of attorney for health care decisions requires a notary if you are granting your agent power to direct your burial or cremation, if not then you only need two witnesses. You may also store your advance directive in the Living Will Lockbox maintained by the State of Nevada.
Durable Power of Attorney
https://www.nvbar.org/wp-content/uploads/power%20of%20attorney%20forms.pdf
HIPAA: Authorization
No specific state form, but if you are the Healthcare Agent, it is considered an authorization.
Medical Directives
https://www.nvsos.gov/sos/home/showpublisheddocument/5217/637915728161300000
Physician’s Orders for Life Sustaining Treatment (POLST)
https://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Reg/DNR-POLST/Docs/POLST-final-0917.pdf
Disposition of Remains Authorization Information
No state form for disposition of remains.
Uniform Act on the Rights of the Terminally Ill, Nev. Rev. Stat. Ann. §§ 449.535 to 449.690
Durable Power of Attorney for Health Care Act, Nev. Rev. Stat. Ann. §§ 449.800 to 449.860
Advance directive and durable power of attorney requires a notary OR two witnesses.
Durable Power of Attorney
https://states.aarp.org/new-hampshire/new-hampshire-uniform-power-of-attorney-act
HIPAA: Authorization
No specific state form.
Medical Directives
https://www.nhcarepath.dhhs.nh.gov/planning-your-future/documents/advancecareplanningguide-2017.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://eforms.com/images/2018/03/New-Hampshire-DNR-Order.pdf
Disposition of Remains Authorization Information
No state form for disposition of remains.
Living Wills Act, N.H. Rev. Stat. Ann. §§ 137-H:1 to 137-H:16
Durable Power of Attorney for Health Care, N.H. Rev. Stat. Ann. §§ 137-J:1 to 137-J:16
Durable Power of Attorney
https://www.nj.gov/dcf/news/COVID19_Power.of.Attorney.Form.pdf
HIPAA: Authorization
No specific state form.
Medical Directives
https://www.nj.gov/health/advancedirective/ad/forums-faqs/
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.nj.gov/health/advancedirective/polst/POLST-Fillable-Form.pdf
Disposition of Remains Authorization Information
New Jersey, is one of few states that require the designated funeral agent to be listed in the will.
Advance Directives for Health Care Act, N.J. Stat. Ann. §§ 26:2H-53 to 26:2H-78
No witnesses are required for either an advance health care directive or durable power of attorney, but it may be helpful to do so in case your advance health care directive is ever challenged.
Durable Power of Attorney
https://coc.unm.edu/common/pdf/nmpoa.pdf
HIPAA: Authorization
No specific state form.
Medical Directives
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.nmhealth.org/publication/view/form/1917/
Disposition of Remains Authorization Information
No state form for disposition of remains.
Uniform Health-Care Decisions Act, N.M. Stat. Ann. §§ 24-7A1 to 24-7A-18
Durable Power of Attorney Act, N.M. Stat. Ann. §§ 45-5-501 to 45-5-502
Two witnesses required for a living will and health care proxy.
Durable Power of Attorney
https://www.nyc.gov/assets/hra/downloads/pdf/services/homelessness-prevention/poa.pdf
HIPAA: Authorization
https://www.nycourts.gov/forms/hipaa_fillable.pdf
Medical Directives
https://ag.ny.gov/sites/default/files/advancedirectives.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.health.ny.gov/forms/doh-5003.pdf
Disposition of Remains Authorization Information
https://www.health.ny.gov/forms/doh-5211.pdf
Health-Care Proxy Act, N.Y. Pub. Health Law §§ 2980 to 2994
Two witnesses and a notary public are required for a living will and health care power of attorney. Not valid if pregnant.
Durable Power of Attorney
TBD
HIPAA: Authorization
https://files.nc.gov/ncdhhs/Privacy%20Release%20Form.pdf
Medical Directives
https://www.sosnc.gov/forms/by_title/_advance_healthcare_directives
Physician’s Orders for Life Sustaining Treatment (POLST)
Disposition of remains included in MPOA forms.
Disposition of Remains Authorization Information
No state form for disposition of remains.
Rights of the Natural Death Act, N.C. Gen. Stat. §§ 90-320 to 90-322
Health Care Power of Attorney Act, N.C. Gen. Stat. §§ 32A-15 to 32A-26
No official state form. Long form provides, Healthcare agent, Living Will, Organ donation all included if the provided sample form.Two witnesses or a notary public required for a living will and a durable power of attorney for health care. Not valid if pregnant.
Durable Power of Attorney
https://www.ndcourts.gov/legal-self-help/power-of-attorney
HIPAA: Authorization
No specific state form.
Medical Directives
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.honoringchoicesnd.org/wp-content/uploads/2018/01/2017-nd-polst-form.pdf
Disposition of Remains Authorization Information
No state form for disposition of remains.
Uniform Rights of the Terminally Ill Act, N.D. Cent. Code §§ 23-06.4-01 to 23-06.4-14
Durable Powers of Attorney for Health Care Act, N.D. Cent. Code §§ 23.06.5-01 to 23-06.5-18
Two witnesses or a notary are required for a living will, but it is not valid if pregnant unless pregnancy won’t develop to a live birth. Durable power of attorney for health care requires a notary or two witnesses.
Durable Power of Attorney
HIPAA: Authorization
No specific state form.
Medical Directives
Physician’s Orders for Life Sustaining Treatment (POLST)
Disposition of Remains Authorization Information
https://fclawlib.libguides.com/ld.php?content_id=64027273
Modified Uniform Rights of the Terminally Ill Act, Ohio Rev. Code Ann. §§ 2133.01 to 2133.15
Power of Attorney for Health Care Act, Ohio Rev. Code Ann. §§ 1337.11 to 1337.17
Two witnesses required for a living will, but it is not valid if pregnant. Appointment of health care proxy requires two witnesses.
Durable Power of Attorney
https://oklaw.org/resource/powers-of-attorney-1
HIPAA: Authorization
Medical Directives
Physician’s Orders for Life Sustaining Treatment (POLST)
https://digitalprairie.ok.gov/digital/collection/stgovpub/id/72721/
Disposition of Remains Authorization Information
https://funerals.org/wp-content/uploads/2017/01/Oklahoma-Designated-Agent-Form.pdf
Rights of the Terminally Ill or Persistently Unconscious Act, Okla. Stat. Ann. tit. 63, §§ 3101.1 to 3101.16
Hydration & Nutrition for Incompetent Patients Act, Okla. Stat. Ann. tit. 63, §§ 3080.1 to 3080.5
Advance directive requires two witnesses.
Durable Power of Attorney
https://www.osbar.org/public/legalinfo/1122_powerofattorney.htm
HIPAA: Authorization
https://www.oregon.gov/doc/Forms/medical-records-release-form.pdf
Medical Directives
https://www.oregon.gov/oha/ph/about/pages/adac-forms.aspx
Physician’s Orders for Life Sustaining Treatment (POLST)
https://oregonpolst.org/wp-content/uploads/2021/07/2019-Oregon-POLST-Form.pdf
Disposition of Remains Authorization Information
https://www.oregon.gov/omcb/Documents/Reference/Appointment-to-Direct.pdf
Health Care Decisions Act, Or. Rev. Stat. §§ 127.505 to 127.640
Two witnesses are required for a living will needs, but it is not valid if pregnant.
Durable Power of Attorney
No Official State Form.
HIPAA: Authorization
No Official State Form.
Medical Directives
https://www.pennstatehealth.org/sites/default/files/HealthcarePOA-EnglishVersion.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://www.health.pa.gov/topics/Documents/EMS/Sample%20Out-Of-Hospital%20DNR%20Order.pdf
Disposition of Remains Authorization Information
No state form for disposition of remains.
Advance Directive for Health Care Act, Pa. Stat. Ann, tit. 20 §§ 5401 to 5416
Durable Powers of Attorney Act, Pa. Stat. Ann. tit. 20 §§ 5601 to 5607
Two witnesses required for a living will, but it is not valid if pregnant and if the fetus could develop for a live birth. Durable power of attorney for health care requires two witnesses or a notary.
Durable Power of Attorney
No Official State Form.
HIPAA: Authorization
No Official State Form.
Medical Directives
https://health.ri.gov/lifestages/death/about/advancedirectives/
Physician’s Orders for Life Sustaining Treatment (POLST)
https://health.ri.gov/forms/medical/OrdersForLifeSustainingTreatment.pdf
Disposition of Remains Authorization Information
No state form for disposition of remains.
Rights of the Terminally Ill Act, R.I. Gen. Laws §§ 23-4.11-1 to 23-4.11-14
Health Care Power of Attorney Act, R.I. Gen. Laws §§ 23-4.10-1 to 23-4.10-12
A living will requires two witnesses and a notary. Health care power of attorney requires two witnesses.
Durable Power of Attorney
https://www.scstatehouse.gov/code/t62c008.php
HIPAA: Authorization
No Official State Form.
Medical Directives
https://aging.sc.gov/sites/default/files/documents/Legal/SCLivingWill2000.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://scdhec.gov/sites/default/files/Library/D-3462.pdf
Disposition of Remains Authorization Information
https://www.scstatehouse.gov/code/t32c008.php
Death with Dignity Act, S.C. Code Ann. §§ 44-77-10 to 44-77-160
Power of Attorney Act, S.C. Code Ann. §§ 62-5-501 to 62-5-505
Two witnesses are required for a living will or durable power of attorney for health care. Not valid if pregnant.
Durable Power of Attorney
No Official State Form.
HIPAA: Authorization
No Official State Form.
Medical Directives
No official state forms for Medical Power of Attorney; Living Will/Directive to Physician.
Physician’s Orders for Life Sustaining Treatment (POLST)
https://doh.sd.gov/providers/ruralhealth/ems/advanced-directives.aspx
Disposition of Remains Authorization Information
No state form for disposition of remains.
Living Wills Act, S.D. Codified Laws §§ 34-12D-1 to 34-12D-22
Durable Powers of Attorney Act, S.D. Codified Laws §§ 59-7-2.1 to 59-7-2.8, 59-7-8
Two witnesses or a notary are required for an advance directive or appointment of a health care agent.
Durable Power of Attorney
No Official State Form.
HIPAA: Authorization
No Official State Form.
Medical Directives
https://www.tn.gov/content/dam/tn/tenncare/documents/AdvanceDirectivesLivingWill.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://endoflifecaretn.org/wp-content/documents/Post-Form-fillable.pdf
Disposition of Remains Authorization Information
No state form for disposition of remains.
Right to Natural Dealth Act, Tenn. Code Ann. §§ 32-11-101 to 32-11-112
Durable Power of Attorney for Health Care Act, Tenn. Code. Ann. §§ 34-6-201 to 34-6-214
Directive to physicians/living will requires two witnesses or a notary public, but is not valid if pregnant. Durable power of attorney for health care requires two witnesses.
Durable Power of Attorney
HIPAA: Authorization
Medical Directives
https://www.hhs.texas.gov/advance-directives
Physician’s Orders for Life Sustaining Treatment (POLST)
Disposition of Remains Authorization Information
No state form for disposition of remains.
Lady Bird Deeds/Enhanced life estate deed
Yes.
Advance Directive Act, Tex. Health & Safety Code Ann. §§ 166.001 to 166.166
Advance health care directive requires one witness and can be oral or written Not valid if pregnant.
Durable Power of Attorney
https://www.utcourts.gov/en/self-help/categories/probate/power-of-attorney-general.html
HIPAA: Authorization
No Official State Form.
Medical Directives
https://ucoa.utah.edu/coreissues/directives/
Physician’s Orders for Life Sustaining Treatment (POLST)
https://bemsp.utah.gov/operations-and-response/ems-operations/advance-care-directives/
Disposition of Remains Authorization Information
https://www.utahfunerals.org/advance-directives
Personal Choice and Living Will Act, Utah Code Ann. §§ 75-2-1101 to 75-2-1119
Durable Power of Attorney
No Official State Form.
HIPAA: Authorization
No Official State Form.
Medical Directives
https://www.healthvermont.gov/systems/advance-directives
Physician’s Orders for Life Sustaining Treatment (POLST)
TBD
Disposition of Remains Authorization Information
https://www.vermontfuneral.org/designation-of-agent-form.html
Advance medical directive requires two witnesses.
Durable Power of Attorney
No Official State Form.
HIPAA: Authorization
No Official State Form.
Medical Directives
https://www.vsb.org/sections/hl/Virginia_AD_Medical_Mental_End-of-Life_Healthcare_FULL.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
Disposition of Remains Authorization Information
TBD
Health Care Decisions Act, Va. Code Ann. §§ 54.1-2981 to 54.1-2993
Health care directive requires two witnesses, but is not valid if pregnant. Durable power of attorney for health care does not require, but does recommend witnesses. No state forms.
Durable Power of Attorney
https://www.washingtonlawhelp.org/resource/questions-and-answers-on-powers-of-attorney
HIPAA: Authorization
No Official State Form.
Medical Directives
https://www.dshs.wa.gov/altsa/home-and-community-services/legal-planning
Physician’s Orders for Life Sustaining Treatment (POLST)
Disposition of Remains Authorization Information
https://endoflifewa.org/wp-content/uploads/2020/02/Designated-Funeral-Agent.pdf
Natural Death Act, Wash. Rev. Code Ann. §§ 70.122.010 to 70.122.920
Durable Power of Attorney Act, Wash. Rev. Code Ann. § 11.94.010
Two witnesses and a notary are required for a living will. Medical power of attorney for health care also requires two witnesses and a notary.
Durable Power of Attorney
https://wvbar.org/wp-content/uploads/2020/03/App-D-WV-POA-Form-2020.pdf
HIPAA: Authorization
No Official State Form.
Medical Directives
http://wvethics.org/advance-directives-forms-and-laws/
Physician’s Orders for Life Sustaining Treatment (POLST)
Must be requested from medical provider.
Disposition of Remains Authorization Information
No state form for disposition of remains.
Lady Bird Deeds/Enhanced life estate deed
Yes.
Health Care Decisions Act, W. Va. Code §§ 16-30-1 to 16-30-24
Declaration to physicians (living will) requires two witnesses, but is not valid if pregnant. Power of attorney for health care requires two witnesses.
Durable Power of Attorney
https://dhs.wisconsin.gov/forms/advdirectives/f00036.pdf
HIPAA: Authorization
No Official State Form.
Medical Directives
https://dhs.wisconsin.gov/forms/advdirectives/adformspoa.htm
Physician’s Orders for Life Sustaining Treatment (POLST)
https://dhs.wisconsin.gov/ems/dnr.htm
Disposition of Remains Authorization Information
https://dhs.wisconsin.gov/forms/advdirectives/f00086.pdf
Declaration to Physicians and Do-Not-Resuscitate Orders Act, Wis. Stat. Ann. §§ 154.01 to 154.29
Power of Attorney for Health Care Act, Wis. Stat. Ann. §§ 155.01 to 155.80
Two witnesses OR a notary are required for a living will, but is not valid if pregnant. Durable power of attorney for health care requires two witnesses OR a notary.
Durable Power of Attorney
https://equaljustice.wy.gov/application/files/5715/5911/9031/Wyoming_POA.pdf
HIPAA: Authorization
No Official State Form.
Medical Directives
https://www.wyoextension.org/agpubs/pubs/B1250-10.pdf
Physician’s Orders for Life Sustaining Treatment (POLST)
https://health.wyo.gov/aging/communityliving/polst/
Disposition of Remains Authorization Information
No state form for disposition of remains.
Living Will Act, Wyo. Stat. Ann. §§ 35-22-101 to 35-22-109
Durable Power of Attorney for Health Care Act, Wyo. Stat. Ann. §§ 3-5-201 to 3-5-213