MAKE YOUR FREE Pennsylvania Advance Directive
What is a Pennsylvania Advance Directive?
The individual making an Advance Directive is known as the "principal," while the individuals or organizations gaining authority to carry out the principal's wishes are called "agents." Suitable for Pennsylvania residents, this Advance Directive is made for use in Allegheny County, Montgomery County, Philadelphia County, and in all other parts of the state. Any Pennsylvania Advance Directive from Rocket Lawyer can be edited to address your unique situation. As a result of this official document, your healthcare providers will have a point of reference for your decisions, and your agent(s) will be able to provide verification that they have the authority to act in your interest.
When to use a Pennsylvania Advance Directive:
- You're making sure your loved ones aren't put in the position of making important end-of-life healthcare decisions for you.
- You're about to draft a complete estate plan, and want to make sure life-sustaining treatments are covered.
Sample Pennsylvania Advance Directive
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LIVING WILL
and
HEALTH CARE POWER OF ATTORNEY
DECLARATION
and
HEALTH CARE POWER OF ATTORNEY
(LIVING WILL)
(HEALTH CARE PROXY)
(LIVING WILL AND HEALTH CARE PROXY)
DECLARATION
and
HEALTH CARE PROXY
LIVING WILL
and
MEDICAL DURABLE POWER OF ATTORNEY
DOCUMENT CONCERNING WITHHOLDING OR WITHDRAWAL OF LIFE-SUPPORT SYSTEMS
HEALTH CARE INSTRUCTIONS
DOCUMENT CONCERNING THE APPOINTMENT OF A HEALTH CARE REPRESENTATIVE FOR HEALTH CARE DECISIONS
OF
DECLARATION
and
HEALTH CARE POWER OF ATTORNEY
LIVING WILL
and
DESIGNATION OF HEALTH CARE SURROGATE
DECLARATION
and
STATUTORY FORM
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
A LIVING WILL
A Directive to Withhold or to Provide Treatment
and
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
LIVING WILL DECLARATION
and
COMBINED DURABLE POWER OF ATTORNEY FOR HEALTH CARE AND HEALTH CARE REPRESENTATIVE APPOINTMENT
DECLARATION
and
DESIGNATION OF ADVOCATE FOR HEALTH CARE DECISIONS
HEALTH CARE POWER OF ATTORNEY
DECLARATION OF A DESIRE FOR A NATURAL DEATH
and
HEALTH CARE POWER OF ATTORNEY
HEALTH CARE DIRECTIVE
and
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
ADVANCE HEALTH-CARE DIRECTIVE
INSTRUCTIONS FOR HEALTH CARE
and
HEALTH CARE POWER OF ATTORNEY
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
DECLARATION
HEALTH CARE PROXY OF
ADVANCE DIRECTIVE OF
LIVING WILL DECLARATION
and
HEALTH CARE POWER OF ATTORNEY
ADVANCE CARE PLAN
HEALTH CARE POWER OF ATTORNEY
LIVING WILL
ADVANCE DIRECTIVE
and
MEDICAL POWER OF ATTORNEY
HEALTH CARE DIRECTIVE
and
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
DECLARATION TO PHYSICIANS
(WISCONSIN LIVING WILL)
and
HEALTH CARE POWER OF ATTORNEY
LIVING WILL
AND
MEDICAL POWER OF ATTORNEY
I. LIVING WILLI. ADVANCE DIRECTIVEI. DECLARATIONI. DOCUMENT CONCERNING WITHHOLDING OR WITHDRAWAL OF LIFE SUPPORT SYSTEMSI. A LIVING WILL - A DIRECTIVE TO WITHHOLD OR TO PROVIDE TREATMENTI. LIVING WILL DECLARATIONI. HEALTH CARE INSTRUCTIONSI. DECLARATION OF A DESIRE FOR A NATURAL DEATHI. HEALTH CARE DIRECTIVEI. DECLARATION TO PHYSICIANS (WISCONSIN LIVING WILL)Declaration made this ______ day of ____________________, _____. I, , willfully and voluntarily make known my desire that my dying not be artificially prolonged under the circumstances set forth below, and I do hereby declare:This is an important legal document known as an advance directive. It is designed to help you communicate your wishes about medical treatment at some time in the future when you are unable to make your wishes known because of illness or injury. These wishes are usually based on personal values. In particular, you may want to consider what burdens or hardships of treatment you would be willing to accept for a particular amount of benefit obtained if you were seriously ill. You are encouraged to discuss your values and wishes with your family or chosen spokesperson, as well as your physician. Your physician, other health care providers, or medical institution may provide you with various resources to assist you in completing your advance directive. Brief definitions are listed below and may aid you in your discussions and advance planning. Initial the treatment choices that best reflect your personal preferences. Provide a copy of your directive to your physician, usual hospital, and family or spokesperson. Consider a periodic review of this document. By periodic review, you can best assure that the directive reflects your preferences. I, , being of sound mind, willfully and voluntarily make this Declaration for my care to be followed if I become unable to express my desires directly as a consequence of physical or mental incapacity or disability, regardless of whether this is caused by illness, accident, or other injury. This document is intended to direct all persons who are involved with my care including my relatives, physicians or personal representatives which I have appointed, or which hereafter may be appointed by the courts.
__________ (initial) I have a terminal condition
__________ (initial) or I have an irreversible condition
__________ (initial) or I am in a persistent vegetative state
AND if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain.
TO RECEIVE artificially administered nutrition and hydration (food and fluids).NOT TO RECEIVE artificially administered nutrition and hydration (food and fluids) procedures, except as deemed necessary to provide me with comfort care.However, if at any point it is determined that it is not possible that the fetus could develop to the point of live birth with continued application of life-prolonging procedures, it is my preference that this document be given effect at that point. If life-prolonging procedures will be physically harmful or unreasonably painful to me in a manner that cannot be alleviated by medication, I request that my desire for personal physical comfort be given consideration in determining whether this document shall be effective if I am pregnant. I have discussed these decisions with my physician and have also completed a Physician Orders for Scope of Treatment (POST) from that contains directions that may be more specific than, but are compatible with, this Directive. I hereby approve of those orders and incorporate them herein as if fully set forth. I have not completed a Physician Orders for Scope of Treatment (POST) form. If a POST form is later signed by my physician, then this living will shall be deemed modified to be compatible with the terms of the POST form.
I designate , who may be reached at , as my Primary Physician.
including but NOT including . unless I initial the following line:
(YOU MUST DATE AND SIGN THIS LIVING WILL AND DESIGNATION
(YOU MUST DATE AND SIGN THIS DESIGNATION
IN THE PRESENCE OF TWO WITNESSES)
I affirm that this Living Will and Designation is not being made as a condition of treatment or admission to a health care facility. I have read and understand the contents of this document and the effect of this grant of powers to my . I am emotionally and mentally competent to make this declaration.
I affirm that this Designation is not being made as a condition of treatment or admission to a health care facility. I have read and understand the contents of this document and the effect of this grant of powers to my . I am emotionally and mentally competent to make this declaration.
I designate , who may be reached at , as my Primary Physician.
We, the undersigned witnesses, state that in the presence of each other and we have witnessed the signing of this living will by . Further, at least one of us is not a spouse or blood relative of .
We, the undersigned witnesses, state that in the presence of each other and we have witnessed the signing of this Living Will and Designation by . I have not been appointed as 's or Alternate . At least one witness is not 's spouse nor blood relative.
I have not been appointed as 's or Alternate . At least one witness is not 's spouse nor blood relative.
Date: ______________________________
Date: ______________________________
The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by , who is personally known to me or who has produced ________________________________ as identification.
Before me, a Notary Public (or justice of the peace) in and for said county, personally appeared the above named , ________________________________, and ________________________________, who acknowledged that they did sign the foregoing instrument, and that the same is their free act and deed. In testimony whereof, I have hereunto subscribed my name at ________________________________, this _____ day of ____________________, ______.
This instrument was acknowledged before me on this _____ day of ____________________, ______ by .
On this _____ day of ____________________, ______, before me personally appeared , to me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed same as his/her free act and deed.
On this _____ day of ____________________, ______, before me, ________________________________, personally appeared , known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same as for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
_________________________________
My commission expires _____________
You should sign this document in the presence of a notary public. You should sign this document in the presence of two witnesses who then sign the document in your presence and in each other's presence. You should sign this document in the presence of a notary public and two witnesses who then sign the document in your presence and in each other's presence.(your Agent)
You should discuss the document and your wishes with any person you want to designate as an Agent before doing so to assure they agree to act on your behalf.
Pennsylvania Advance Directive FAQs
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How do I make an Advance Health Care Directive in Pennsylvania?
It is simple and easy to record your medical preferences using a free Pennsylvania Advance Directive template from Rocket Lawyer:
- Make your Advance Directive - Answer a few basic questions, and we will do the rest
- Send or share it - Discuss the document with your healthcare agent or seek legal help
- Sign it and make it legal - Optional or not, notarization and witnesses are encouraged
This method, in most cases, would be notably more affordable and convenient than finding and working with your average law firm. If necessary, you may fill out this Advance Directive on behalf of an elderly parent, a spouse, or another family member, and then help that person sign after you've drafted it. Please keep in mind that for this document to be considered legally valid, the principal must be an adult who is mentally competent when they sign. In the event that the principal has already been declared legally incompetent, a conservatorship might be necessary. When facing this situation, it would be a good idea to talk to a lawyer .
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Do I need to make an Advance Directive?
Everyone over 18 years old should have an Advance Healthcare Directive (both a Healthcare Power of Attorney and a Living Will). Although it may be challenging to acknowledge, a day may come when you are no longer able to make your own healthcare decisions. Here are some typical situations where you may consider it helpful to make or update your Advance Directive:
- You plan to undergo an in-patient procedure requiring anesthesia
- You are getting older or dealing with ongoing health issues
- You've been diagnosed with a terminal condition
- You are preparing to live in a care facility
Regardless of whether your Pennsylvania Advance Directive is being created in response to a change in your health or as part of a long-term plan, notarization and/or witnesses can often help to protect your document if anyone disputes its credibility. In Pennsylvania, Advance Directives that contain your medical treatment preferences are not valid when the principal is pregnant.
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Do I need to work with an attorney for my Advance Directive in Pennsylvania?
Making an Advance Directive is typically simple; however, you or your agent might still have questions. It will depend on whom you reach out to, but often some attorneys may not even accept requests to review your document if they were not the author. A more favorable approach might be via Rocket Lawyer attorney services. By becoming a Premium member, you will be able to ask for guidance from an experienced lawyer or send other questions about your Advance Directive. Rocket Lawyer is here for you.
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On average, how much would I normally have to pay to make an Advance Directive in Pennsylvania?
The fees associated with working with a law firm to draft an Advance Directive could range anywhere from $200 to $1,000, depending on where you are. Rocket Lawyer isn't your average Advance Directive template website. With our service, anyone under a Rocket Lawyer Premium membership can take advantage of up to a 40% discount when hiring an attorney.
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Would I need to do anything else after I write my Pennsylvania Advance Directive?
Attached to your Advance Directive, there is a set of next steps to take after the document is completed. With a Premium membership, you will be able to make edits, save it in Word or PDF format, print it, and sign it. Finally, your agent(s), care providers, and other impacted parties should get a copy of your final document.
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Does an Advance Directive need to be notarized or witnessed in Pennsylvania?
The requirements will be different in each state; however, in Pennsylvania, your document typically requires the signature of two witnesses. The principal may sign by signature or by mark, or they may direct another person to sign on their behalf. Where applicable, the witnesses to an Advance Directivel must not include the person who signed the document on your behalf. As a general principle, witnesses must be 18 years old or older, and none of them should also be your healthcare agent.
