Idaho Living Will Template
This Living Will is created in accordance with the laws of the State of Idaho. It outlines your wishes regarding medical treatment in the event that you are unable to communicate your preferences.
Personal Information
- Name: __________________________
- Date of Birth: ____________________
- Address: _________________________
- City: ____________________________
- State: ___________________________
- Zip Code: ________________________
Declaration
I, the undersigned, being of sound mind, willfully and voluntarily make this declaration regarding my medical treatment. This Living Will reflects my wishes regarding life-sustaining procedures in the event that I am unable to express my wishes due to a terminal condition or irreversible coma.
Wishes Regarding Medical Treatment
- If I am diagnosed with a terminal condition, I do not wish to receive the following treatments:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Dialysis
- Tube feeding
- If I am in a persistent vegetative state or an irreversible coma, I do not wish to receive the following treatments:
- Life-sustaining procedures
- Any treatment that would prolong the dying process
- In all other situations, I wish to receive all appropriate medical care to keep me comfortable.
Appointment of Healthcare Representative
I designate the following individual as my healthcare representative to make decisions on my behalf if I am unable to do so:
- Name: __________________________
- Phone Number: __________________
- Relationship: ____________________
Signatures
By signing below, I affirm that I understand the contents of this Living Will and that it accurately reflects my wishes.
- Signature: ______________________
- Date: __________________________
This document must be signed in the presence of two witnesses or a notary public. Witnesses must be at least 18 years old and cannot be related to me or entitled to any portion of my estate.
Witnesses
- Witness 1 Name: ___________________
- Witness 1 Signature: _______________
- Date: _____________________________
- Witness 2 Name: ___________________
- Witness 2 Signature: _______________
- Date: _____________________________
This Living Will is intended to ensure that my healthcare preferences are honored in accordance with Idaho state law.